I'm a long time on and off lurker here, and have really appreciated everyone's information and advice. I figured it was time I introduced myself and told my story . . . maybe someone will have some suggestions for me.
I think I first had an AF in 2005, I was 25 years old. I was traveling in Guatemala, had a hard stool, and incredible pain for weeks afterward. Finally I went to a doctor, who (mis)diagnosed me with hemmroids and prescribed a steroid cream. I also called my primary care doc back home, who advised me to get a sigmoidoscopy because of the blood I was seeing. So, I went to a fancy clinic in the nicest neighborhood I could find in Guatemala city. They sent me home with a video of the inside of my intestine and said I was fine, just hermmroids.
I eventually got better, using the prescription ointment and later prep H suppositories. It would come back every once in a while, but rarely, and the suppositories would help, sometimes I used some aloe. It was never as bad as that first time until . . .
Probably 2014ish it came back and was brutal, and I finally went to a CRS who told me I had a fissure. She prescribed nitroglycerin cream, which I used, and healed. I had a couple flare ups between then and 2018, when I delivered my first baby in January. I was terrified of the post pregnancy poops given my history, and was relieved when they didn't really hurt. But a couple months later, I think due to dehydration from breastfeeding, the fissure came back and I was MISERABLE. Trying to care for a newborn and in so much pain.
So back to the doc I went. She gave me the nitro again, and said I could use it while breastfeeding but that there was really no data on how it affected the baby, so to use it right after feeding him. So I did, but I was a little nervous about it. I used it until I felt better but didn't continue the 4 weeks she recommended after that, because I didn't want to have my baby eat it if I didn't really need it. Well that was probably a mistake. Basically once a month since then the fissure has come back. When it does, I resume the nitro, start taking Miralax (can't take long term because it gives me stomach aches after a few days) and usually feel better after a horrible week.
The last time this happened, in March, I decided ok, I'll continue the nitro for the full course since I'm only breastfeeding twice a day now, and I don't think he gets much milk anymore anyway. I was running low on the nitro so I only did it once a day after the first few days. I was good until middle of last week, and then retore.
I have tried all combinations of nitro, neosporin, lanolin, and estrogen. I use vaseline before BMs and usually squat. I take Miralax, magnesium (500 mg a day, just increased to 750) and Vitamin C (1000 mg a day). I drink SO MUCH water. I just got a refill of the nitro so my plan is to do the real full course 3 x a day, estrogen a couple times a week, and the carlson suppositories I just ordered when they arrive. I sometimes take baths but I have a full time job and a toddler, so that's tough.
Maybe this is all futile and I should just get botox, or surgery.