I just found this site today, didn't see this topic in the threads. I'll start with my Long Story feel free to skip it, this is just in case anyone is still going through and can pick up anything from it.

Before 2022 I had never suffered from Anal/Rectal pain, but that all changed with a vengeance last year.

[+] "Here is the long story if you are intersted"

March: pain began, Gastroenterologist (I have IBS) pointed me to my GP, who referred me to a Colorectal surgeon

April: I got in to see a CR Surgeon who after a digital exam said it's not hemmorhoid, couldn't be a fissure cause I didn't jump off the table with the digital exam, so he decided must be proitus ani told me to use Desitin

May: Pain getting worse, went back to CR Surgeon who did no internal exam and doubled down on his proitus ani diagnosis and prescribed a steroid cream. I reiterated this isn't an itch this is pain, but he held pat.

June: Pain still getting worse, found another CR Doc for a 2nd opinion, he used a scope and immediately said "You've got a fissure", he put me on Nifedipene cream. One week later, pain is up to 6-8 not sleeping some nights, he switched me to Nitroglycerin cream. I got the headaches, but actually was in so much pain I welcomed the headaches as they seemed to be a little distraction from the rectal pain. Another week later, he tells me that the conservative treatment isn't working, I may want to consider Sphincterotomy (sp?). We agree to continue Nitro treatment and schedule the surgery out in Mid-July.

June 26: Pain is off the charts, can't sit, lay, stand, or walk more 10 minutes without incredible pain. I had one tilted sitting position on the couch that I could live with the pain, and suddenly even that wasn't working. I didn't see how I could wait 3 weeks for the surgery. I went to the ER hoping they would drug me up, admit me, and do the surgery within a day or so. ER doc noted alot of swelling and did a CT scan, said didn't see any emergency told me to followup with my CR doc.
June 27: Called my doc about the ER, he said come in that day just to make sure everything is the same and there won't be any surprises at the surgery. He did initial look and said "Well now you have an Abscess" said we can't do the surgery with an active infection. I had him drain the abscess that day in the office. By the next day I felt 99% better
this was it, the pain I had been experiencing since March was gone.

July: 2 weeks after draining the abscess I wanted to hug my doctor when I got in the office, I felt so much better. He examined and said I have a fistula at the abscess drain. We decided to schedule a surgery (don't know the name) to: Cauterize the fissure which would hopefully allow the fistula to heal
August: Had the surgery and all went according to plan. A couple of weeks later doc said Fissure healed, Fistula healed, just waiting on Post Op to heal

Which brings me to today, I had the surgery in August, Fissure and Fistula healed, I've been back to the surgeon 5 tiimes, no more pain, but still have blood every couple of weeks or so for a single BM. Doc says it is healing, but REALLY slow and it is just the Post Op (whatever that means)
I've been on high fiber, metamusil, lots of water, prunes, low meat diet. I have soft regular BM's and have been on Nitroglycerin and sitz baths for 6 months. Any ideas why this wouldn't heal, any advice?

I'm not sure if you are a woman or man, but in women low estrogen can sometimes cause thin skin and slow healing down.

Thanks patience_and_healing.

I guess I should have provided more context.

I'm 46 year old Male so likely unrelated to estrogen but my specialist did put me on steroid enema for 7 days after the first time I saw him, hopefully that didn't thin my skin.

7 days isn't that long so most likely that's not the cause. You could also consider seeing a dermatologist.