I was waiting a little before posting about my breakthrough because I wanted to be sure that my sudden improvement was real - and while I know that it can take 1 year for a fissure to fully and completely recover its strength, I think that I can say with some certainty that I'm on a great track now.
I've had my fissure for 3 months - the usual story, pain, blood, despair with each BM. My fissure was always painful, but not disabling like some members of the forum. But blood was constant, in 3 months I never had more than 2 days without some amount of blood, and often the amount was considerable to the point of making the toilet water bright red.
I had tried all the recommended stuff - high fiber and super healthy diet for all the time. Diltiazem and Nifedipine cream. Things were helping me some, but I'd always, I mean ALWAYS have setbacks and even when things were good, they were never great.
Well, things have been GREAT for 2 weeks now. And this sudden improvement can be directly traced to 2 key changes to what I was doing... Read below!
3 weeks ago I went to South America to visit part of my family who lives there. They were fully aware and prepared for my condition. When I arrived, I was suggested by a family member to visit a private CRS, possibly the very best in the country. Now, we'd think that American and UK medicine is great, and it is indeed great. But make no mistake: you can't compare a health insurance doctor to an expensive private doctor, even one from a "developing" country as you will see.
My first week there wasn't great - I still had the fissure, blood, pain etc. Being there was good, but the fissure spoils everything as you know. So well, there I go to the doctor, without that much hope, but I thought it was worth a shot.
It was a really long and thorough appointment - I stayed literally 1 hour with the doctor (some small talk too). He examined me visually and with his finger, and said that I had an open 1cm fissure. He was surprised when I said I was using Nifedipine and said "well, the medicine is right, but it is simply not working. Your internal sphincter is really tight, thus you can't heal". We all know that.
Then he went and said that while Nifedipine and Diltiazem are good for this problem, he doesn't use either. I said "sure, you use nitroglycerin".
He said: "Nope".
He then says that in the past, LIS was how he handled fissures that wouldn't respond to medicine. But it had been FIVE YEARS since he last performed LIS - and he said also that fissures are a very common problem and although very painful, not really serious (this guy routinely performs 10+ hour surgeries and describes some of the really nasty ones to me!).
The medicine that he had been using in the last 5 years is ISOSORBIDE DINITRATE - a medicine, according to wikipedia, in the same family as Diltiazem and Nifedipine. Gosh, I had been researching fissures for 3 months and NEVER heard about it. Since he started using this medicine, not a single patient ended up needing surgery. I'll talk more about that in a second.
Then he asks me about my bowel movements prior to the fissure, and I said that I'd normally go once a day, very regularly - never constipated. I was then going 3-5 times a day under my high fiber diet with a bit of Miralax.
He says: "Alright, so you will cut all this fiber. If you are regular like you say you are, you don't need a high fiber diet. Just eat your regular fiber amount (which wasn't all that much)"
I ask: "Can I eat anything? I lost almost 10 pounds in this high fiber, healthy diet... Can I eat pizza (I was being sarcastic actually)?"
He says: "Pizza, meat if you want, eat ANYTHING but spicy and heavy stuff. Just eat normally, really. You say you're having a bit of Miralax, keep having some of it until you're 100%.".
I was very surprised! I left and went to buy a tube of Isosorbide (12 US Dollars at the best local compounding pharmacy!). Also, I started eating WAY MORE, and eating pretty much everything - chocolate, pizza, bread etc. To be honest, I didn't go commando and eat a lot of the bad stuff, but I ate some of everything, no restrictions on variety really. I was eating a ton of cookies actually (I love cookies). And I started using the Isosorbide.
Oh well. TWO DAYS later it was GONE. 12 bucks and eating normally did the trick - GONE, GONE, GONE. In the past 2 weeks, I've felt completely normal with not even a speck of blood or a little itch on the fissure - ZERO pain.
I've been having 1-2 BMs a day, they have been soft (Miralax is helping here, but I just have 2g/day instead of the regular 17g) and painless. I haven't been getting very large stools, but very long instead, the way it should be I guess.
I have no idea of what's ahead for me - but I hope this long story can help some people in this forum. My life is back, at least for now. Please let me know if you have any questions or if my CRS' recommendation helps you...

isosorbide dinitrate
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From HouseMD To dan2012, Today at 2:49 pm
Hi Dan;
After you posting this I actually found quite alot of clinical trials with a +90% success rate with this medicine, but for some reason GTN and Nifedipine get all the press. However all the trials don't go into detail of how to apply or the concentration.
What was the concentration of the ointment? I've seen 1% up to 10% used; and what was the base (petroleum?)
Did you apply this internally or externally, how did you apply?
Thanks a MILLION for sharing

I think one of the secrets here is that your fissure had not reached the chronic stage but was still in the acute. Best of luck with that medication. Can't wait to read more about it in the USA when there is some...

Hello savaici, sorry for the delay. I also responded to HouseMD in a private message, but I'll repeat what I said below:
1) My fissure was NOT acute (unfortunately) - I have a skin tag and it had been open for around 3 months. The multiple doctors that looked at it called it chronic, although they all found it would heal eventually based on how it looked (don't know exactly why).
2) I applied it externally like everything I ever used. All doctors, including the "miracle" one that healed me, advised strongly against applying internally. The amount was around 1-2 pea size, twice a day.
3) The cream looked like white toothpaste, the base is "lanette cream", I think it's petroleum base. The concentration was 2%.

Hi, I'm new to the AF world. Can I just ask, did you have surgery for the AF w/out success?

Hello porfirio,
No, I didn't have surgery. I tried "conservative" treatment (fibers and medicine) and the combination in my post above is what did the trick after 3 months of trying different things.

Is this medicine by prescription only??

I think so. However, I got it outside of the US when traveling overseas (south america). Here it would be the same as Diltiazem or Nifedipine...