I've been suffering from AF for almost 6 months now. The first 4 months I did nothing and hoped it would go away by itself (bad decision). It didn't .. and then turned chronic. Ouch.
My main concern was constant tear/heal/tear cycle that my AF was going through and it felt that it will never heal every time I went for a BM. I stuck to it though and the last time I had re-tear, blood or pain was 6 weeks ago, my AF is very nearly healed (will give it another full month before celebrating .. you never know!).

Just wanted to share what I did in the last 6 weeks or so hoping that this will help someone.

1. I stopped using GTN (used it for 3 weeks without any benefit) and switched to Diltiazem 2% ointment (twice a day for 4 weeks then once a day for another 2 weeks). Can't thank the CRS enough who prescribed it to me. I asked my GP why bother with GTN at all and he just smiled and said 'They have a bigger marketing budget'.

2. From my experience, ointments on their own won't heal the AF. The most important thing is keeping the BMs soft .. this was the crucial point that turned things around for me. I have been taking Lactoluse (33%, 9ml three times a day .. now reduced to 9ml once a day) + psylium husk (about a teaspoon once a day after dinner). Having soft BMs mean less chance of re-tear and give AF chance to heal properly.

3. Water, water, water .. at one point I was drinking seven to eight 24 oz cups of water a day. Having too much water can cause your body to lose salts and minerals too quickly. Use replenishing supplements if you think you are going to the toilet too often. Doesn't matter what what diet plan you're on or what laxatives/softeners you're using; you need water to keep it all moving and soft.

4. Stopped going out for walks as I felt it irritated my AF and made it sting.

5. Keep the bottom area clean. Take sitz bath, shower or whatever .. but make sure you keep the rectal area as clean as possible. I personally used wet (dripping) toilet paper to clean myself and made sure I went in as far as I could. I found that any bits that get stuck in the crevices can chaff the skin and make the whole thing swell up and delay the healing process. Keeping good hygiene definitely helps.

6. Everyone would recommend eating foods rich in fiber, so I was all bran and peas for a few days. A big mistake. When your AF is raw, eating too much fiber will bulk up the BMs and cause a re-tear every time you go (and trust me; you'll be going at least once a day). The trick was to increase fiber intake ever so slightly and that too of the soluble kind (oats worked for me) and wait for your AF to partially heal .. and only then start eating foods high in soluble/insoulble fiber to keep things regular and soft. Take it slow

7. Don't give up. Keep at it. There will be days when a hard BM will surprise you and destroy your week's worth of progress in a few seconds but don't give up. I had a hemm flare up right around where the AF is and I was in total agony around week 4 when I had almost healed. Fissure had teared completely and nothing I did seemed to help .. was almost about to go for botox when I 'gave it a few more days' and now here I am .. almost healed.

For the peace of mind I even went for a flexible sigmoidoscopy this week and got an all clear .. so make sure you talk to your GP/Surgeon if you have any concerns at all .. don't suffer quietly!
I'll do a detailed post in the success stories section when I'm absolutely sure I'm healed (still got 2 weeks of Diltiazem to go and also Lactoluse etc.).

All the best!!!!

This is all great advice, Shakdang. Right on point, all from your own personal experience. Thanks for telling us what you did, and how successful it was. I hope you will reassure and inspire lots of people with your story.

Thank you. I think I am mostly re-iterating what has already been many times before but hopefully this will help someone out there.

Very helpful advice shakdang. Thanks for sharing. I am glad to hear you are doing so well. I hope you will be posting your success story very soon :)

Thanks msimon. I've stopped using Diltiazem completely since making this post (a little over week now) and so far so good.

I'll give it a few more weeks and then hopefully a detailed post in the success story section :)