I use .5% Nifedipine maybe 3 times a day. Honestly, I don't really notice that it does much for me. I apply it on the outside, so not sure if that's correct or not. I try to apply it maybe 10 to 15 minutes before a bm, but not always possible. I am very, very regular. Usually 1 bm every single morning, first thing. If I don't "empty" well, then I usually go again a few hours later.
My diet now consists of high fiber cereal for breakfast, progresso high fiber soup or a sandwich made with high fiber bread, a bowl of high fiber oatmeal for snack and then something high fiber for dinner, like high fiber spaghetti or maybe chicken with veggies. I eat sweet potatoes almost every day too. I do not take any fiber supps though. I've tried taking them, but I don't seem to do well with them.

Firstly, although many here may disagree, I think you need to get the ointment upwards at least 1 cm. That's what the Mayo CRS told me, and I've always tried to do that. The Pelvic Floor Retraining class teaches a person to relax the muscles and to learn how to expel a water-filled balloon, which I was unable to do during the test. But I was able to do it after taking the class. How long have you been using the ointment???????

Ya, I was also told to get the ointment into the anal canal when I used Nitro paste. I would take a Q-tip and very gently apply it. This also helped by not getting the Nitro paste on my fingers. My CRS said a lot of people get the headaches from the amount they end up with on the fingers.
In my location, I couldn't get Nifedipine topical. So they prescribed it orally. It is the only conservative measure that actually helped me. I healed my first fissure to the point of being tolerable with the oral Nifedipine. Last summer when I tried it again for my second fissure I got to light headed and my heart raced so that was the end of using it for me.

I have been using Nifedipine ointment since January. Ideally, I feel like it needs to be applied in the canal, but my canal is so tight that I generally cannot insert anything into the canal to apply it that way. The hardest part about trying to decide on the surgery is that I cannot get the surgery locally, so I need to find someone to do it out of state and I am not familiar with any out of state CRS's and I definitely don't just want to "pick one" who's willing to do the surgery. I want someone is who very skilled at this type of procedure. I found a surgeon in Dallas who is willing to do it, even if I do not have an active fissure, but I don't know anything about him.

Could you try Botox? I'd probably fly to Mayo Minnesota, but that's just me.

I would be in the same boat with the botox, cause I haven't found anyone locally who uses it. I may look into scheduling an appt. at Mayo in MN. Just out of curiosity, do the majority of the people on here have significant pain while having BM's when they have an active fissure? I generally do not have much pain with bm's, but my pain tends to intensify over the course of the day. Usually really starts to kick in about an hour or two after bm. Thanks for the help.

For me when the fissure first happened it felt like passing shards of glass. After mine became chronic I would have a slight discomfort during BM (rarely any blood) and then a lot of pain that would build afterwards. I think this is the sphincter muscle going into spasm. Mine would tighten up so much that walking was hard at times.

Paul, the strange thing about my situation is that even in the absence of an active fissure, I have pretty bad rectal discomfort that usually builds over the course of the day. I have had times where I was certain that I had an active fissure and when I went to the CRS I was told that there was no fissure. So for me, I have a really hard time distinguishing between my "normal" pain and fissure pain sometimes. My rectal problems started way before I ever had my first fissure, so even when my fissure heals, I'm still in pain. But, I have had the "passing glass" feeling and generally that is a pretty definite sign that I've developed a fissure, but I've never had any blood. Right now, my pain is really bad and I'd swear that I have a fissure, but I have no blood and this weeks bm's have not really been very painful. Certianly no passing glass pain. If I schedule an appt. now, I might get in to see the CRS in about 6 weeks or so, which by then the fissure might be healed, so what am I supposed to do.

Just wanted to chime in since I've had fissure for over a decade (recently did the surgery, not totally healed yet).
I had intense glass shards pain with hours of intense pain afterward bm the first time it happened but over the years the pain decreased somewhat during bm and hurt more afterwards. In addition to the itching and pain when walking. I usually had blood the first few days along with low grade fever and tiredness.
As for magnesium, I take MagO7 (on a break now). Two pills at night worked for constipation but I took one pill at night every day for a month to keep bm soft....and I wasn't eating the best either. I tried taking it after my surgery with the stool softner and Miralax but that was overkill. I stopped taking all three at the moment and only do Benefiber mixed in my oatmeal once a day, one pack Metamucil wafers (very good), and high fiber foods to get me to the 20-25 grams of recommended fiber for the day. Also drink 2.5-3 liters of water per day.
I know you mentioned that it's difficult for you to get the cream in the anal canal. Just wanted to suggest try using a finger cot (rubber "glove" for one finger) and press gently but firmly around the non-irritated edge of anus and it may relax enough to get a little bit inside. I know it's hard to do anything with a furious fissure and subsequently angry anus but might be worth a try.

Mm,
They do Botox at MN Mayo. That was going to be my next step if the Diliatzem didn't work for me. The Mayo CRS told me via phone that they are very conservative there in regards to LIS--using that surgery as the absolute last resort. My Mayo GI doc advised me against LIS in my case as he knows I would have a very difficult time with incontinence since every little thing bothers me.