Hi Hopeful Lad,
And welcome from another newbie 50's British male sufferer. I've had just a few longer term fissure problems, recurring occasionally over a few years. Normally I'm an analytical, logical, relatively calm and well-balanced sort of person - but recently had periods of depression brought on by the fissure, and not really mentioned it to anyone. When I recently posted here I got the same invaluable sympathy and tips as you're getting - and my mental health has improved (I was tempted to try some sort of poor word play about getting it out here on the forum being cathartic).
I don't have the complications you've had, and you do seem to be covering most of the usual bases: diet, stool softeners, water, exercise, healing and pain alleviation. I'm scared of operations so trying to treat my AF conservatively by all of these methods, and just recently the onslaught of all of these seems to be easing the pain. When my BMs have been painful and I've been scared to go I have found myself holding back. Perhaps like you I've often had more pain a few hours after a BM than at the time, and never been sure why that might be. In the past mine has just eased and then disappeared and I've not been sure exactly what has helped that - or indeed what has brought it on again...
On the possible complications of LIS: as I've said elsewhere on this forum I sometimes worry that we hear more from those who suffer continuing problems than those who are cured. It is understandable that those who have LIS and improve probably don't have the motivation to carry on posting on this sort of group much - they just get on with their lives. On the other hand those who are not sorted out are probably more likely to engage us with their problems. I'm sure you will have seen the reviews - for instance http://www.origynrx.com/technical_reviews.asp which generally show good success rates for LIS. If you do go for the LIS and it works - please would you be sure to let us know.
Presumably you are a hot (sitz) bath, and hot pad user (I sit on one at work - and I'm fortunate I've got great work colleagues and bosses who are understanding). As an aside we've just recently got a new car and we've got heated seats - if you ever get the chance I'd recommend that option (an essential part of the option pack for AF sufferers!).
Do you manage to get enough exercise (one of the few things you haven't mentioned which I'm led to believe can help - and seems to help me)? I'm on GTN at the moment and awaiting some Diltiazem from the pharmacists - any tips on Diltiazem please?
So you've got good friends here, lots of understanding and sympathy and plenty of advice. It does strike me that there is a wide divergence in the exact symptoms and treatment for AF, and trying various combinations is the order of the day and that has also helped me feel I'm doing something - rather than just suffering.
Keeping busy at work or absorbed in something else at home has also helped take my mind off the pain and hence helped me feel better.
So please stay strong and positive - I'm sure you'll beat it: you've clearly got the tenacity and done the research.