I received a lot of useful information from this forum, and reading the success stories gave me hope during the most painful moments. I'm posting my story in an effort to help others. The short answer is LIS surgery was what finally did the trick.
I got my anal fissure in late May of 2017. It took me eight months to heal it. If I knew then what I knew now I could have healed it in a couple of weeks.
Weeks 1-2: hoped it would go away on its own. Did sitz baths, coconut oil, eating less. No doctor visits or prescriptions, No effect.
Weeks 2-4: went to the gastroenterologist I had seen for hemorrhoid banding and he prescribed 0.2% nitroglycerin ointment. I tried this for a couple of weeks with no effect.
Weeks 4-8: gastroenterologist upped my prescription to 0.4% nitroglycerin ointment, again with no effect.
At this point the fissure was bad enough that I was missing days of work and I was in a lot of pain for the first 5-6 hours of the day after a bowel movement. Life was pretty bad.
Months 2-8: My gastroenterologist switched me to Diltiazem. This helped a lot. This brought the pain down to a bearable level where I was able to go to work and it helped heal the fissure to an extent. This was also about when I found this forum and discovered Miralax, which was a huge help. Thank you! I also started modifying my diet: no red meat, no coffee, no alcohol. Red meat ran the risk of constipation, coffee and alcohol acted as laxatives for me and made me poop more than I needed to. I ate mainly cereal, oatmeal, eggs, chicken, fish, fruits and vegetables. I tried additional fiber (Metamucil) but this was actually a bad thing. I was already regular (I poop once a day every morning) and all the fiber did was make larger, bulkier poops, which were more painful on the fissure.
All of these combined things got the fissure pain down to a tolerable level where I could function but it didn't completely heal the fissure. I was still unable to stand, walk, or run for any amount of time/distance in the mornings. I was still cancelling any travel plans. Months 2-8 were a zone of tolerable pain, some improvement, a backslide, improvement, than another backslide. Also at this point I had developed a sizable anal papilla associated with the fissure that was large enough to prolapse when I pooped, pulling on the fissure and causing a fair amount of pain on the days it did prolapse. There was no way to fix this other than surgery. I started interviewing colorectal surgeons in the area.
Month 8: I had LIS surgery January 15 along with the surgical removal of the anal papilla. The procedure itself was only about 20 minutes and my total time in the surgical clinic was a few hours. I left the clinic in no pain, having been injected with a long acting local anesthetic. I left at around 2:00 PM and started feeling the first slight twinges of pain at around 10:00 PM.
The very next day after surgery was an amazing experience. There was some surgical site pain when I pooped but there was none of that burning fissure pain. I also had no incontinence problems. I took one 10 mg Percoset once a day roughly 15 minutes before I pooped for the first four days after surgery. I didn't feel a need for any painkillers after that. I was on a pretty large dose of milk of magnesia the first few days after surgery to prevent any stress on the surgical site.
About five days after the surgery I was largely pain free when having a bowel movement and afterward and was also off any laxatives, so the poops were essentially normal. Four weeks after the surgery all drainage from the surgical site had stopped and it was like the whole fissure thing never happened. I was back to my old self again.
It's now been eight weeks since the surgery and I feel great. I'm off all laxatives and eat whatever I want: steak, pizza, alcohol, coffee, etc. If I knew back in May 2017 what I knew now I would have booked an appointment with the surgeon the day I felt the initial pain. I lost eight months to this little devil. Hopefully my notes here will help others. Don't be afraid of the surgery. Do some research, interview a few colorectal surgeons in the area who have good reviews, and then sign up for the procedure. For me, the surgical pain was much less than the fissure pain, and the benefits were immediate.
I live in the Southern California area and had my surgery with Dr. Babak Rad in Newport Beach. I highly recommend him. He's skilled, straightforward, and caring. He never pushed me into surgery and clearly laid out all of the options. He saved my quality of life!
Mike