Way too soon to declare victory, but I've now had 11 good days in a row. By "good" I mean the passing-glass-shards feeling during BM is muted, and the burning, the crampy aches, the stabbing pains for hours on end after BM are pretty much gone. At most, there's still some lingering burning feeling, but at a tolerable level and gone in perhaps 30 minutes. Again, I don't want to get my hopes up too high, but at the moment I am a happy camper.

Briefly, my regimen that got me to this point is: diltiazem ointment applied deep and liberally twice daily; coconut oil suppository once daily; nice warm shower w/ direct application to the area right after morning BM; 100mg ducosate stool softener once daily at bedtime; and an overall VERY good diet for many years (no sugar, no processed foods of any kind, no fast foods of any kind, all real whole foods, meat, poultry, fish, eggs, veggies, fruits, lots of organic, grass-fed, wild-caught, etc etc) but specific to the AF, I revised my food choices to put much greater emphasis on soluble fiber.

QUESTION! I am nearly out of diltiazem ointment. I wonder how I should approach the weaning off of diltiazem. If I start cutting back to once daily now, it'll last for perhaps another couple weeks. Or should I just pay the $45 and get the prescription refilled, and continue with it for a while longer? I am going to have to quit using that stuff *someday*.

Sure sounds like you are healing :)

If you have no issues tolerating diltiazem, I would continue it twize daily for some more weeks. Usually doctors tell us to use diltiazem or nitro for 6 weeks even if we heal in the meantime. Im pretty sure this is because the healing process continues for quite some time after the pain has gone down.

Thanks JHH. I have no issues tolerating the diltiazem (meaning, side effects like headaches, I suppose) Nope, nada. Oddly my PCP who prescribed this round had basically nothing to say about proper usage. I haven't seen the CRS since my first tear in '09, but I did a failed round of diltiazem back then too, and frankly he didn't have a lot to say about proper usage either.

Your advice sounds good. Stay on it a while longer.

Soffiler,
You sound great! Your regime is a good one and that reduction in pain is an extremely encouraging and positive sign.
I used Diltiazem regularly for 7 weeks and throughout the course of doing so, began to feel better & better, just like you. I was actually so scared about weaning off the cream because I was terrified I'd get a repeat of all that awful pain. Eventually my CRS insisted I stop and I did and guess what? Nothing bad happened!! and I was then able to prove to myself that I was indeed healing! - Not completely healed, I hasten to add, but the cream had done what it was intended to do and had started the healing process. I continued to get better & better and it took a long time to reach full healing naturally but it happened in the end.
Definitely use the cream, even if you need a repeat, for the length of time advised by your CRS (as JHH says generally 6-8 weeks) and don't be afraid to stop when you have to. You sound truly like you are doing really great!
All the very best in your continued healing :)

Thanks, Optimist... the one comment I'll add is that my CRS (last seen in '09) never advised a particular length of time for the diltiazem. I might be within the 6-8 weeks you folks are discussing with this current batch, so maybe I shouldn't refill the script. (It's $45 out of pocket, which is no big deal, but is also a pure waste of funds if I don't and more importantly *shouldn't* be using it)

Hi Soffiler,
If you feel you've been on the cream for the length of time required and don't essentially want to pay out more, I wouldn't worry about the repeat either. You will have a far more accurate indication of how you feel when you stop using it anyway.
It really is a relief to stop having to worry about applying the stuff anyway and in the long term, your bum will be better off if you don't need to be using it. I also don't like having to use ointments & stuff in the area because it's not really what nature intended! but obviously at such times, it is a must.
Fingers crossed this has worked for you & the all important healing process has started to kick in now :)

In my experience. The most important weapon in this battle, is soft stools. Next is no pushing, and third is ointments. So, if you keep it soft and nurse your butt, Im sure you will do fine without dilt. However, personally, I would like the extra security ointments provide, for a little while longer.

Whatever you choose, good luck with the healing!

Well, I'm still using the ointments months into healing. It has only been recently that I haven't had spasm pain after natural ly healing from a very bad AF. It helps with lubrication during BM's, reducing spasm pain and I have no bad side effects. I'm almost 8 months after my last bad retear and just starting to think about weaning. Oh, at times I have used diltiazem..other times nifedipine. I'm planning to continue a lubricating agent like A & D ointment after I stop the prescription cream. My advice is to not hurry it! I tore after a month of thinking I had healed the first time around...big mistake. Months more of pain. I'm going much more slowly with weaning from everything! I'm probably on the 'extreme' end of usage time but wanting to save others my fate!

That's just the kind of advice I was looking for. VERY sorry about the re-tear... I'll try to learn from that and take it slow.

Thanks for the sympathy! I feel SO much better these days...I've improved week by week and month by month. I hope you do well with your healing!