Thought I was having a "rhoid" flare, but after 4 weeks realized it was way bigger. Finally got the mirror out last week and noticed a small lesion on my perineum. Found fissures by searching the internet and found you guys. I've a high threshold for pain, but this had me crawling out of my skin and climbing the walls with the itching and pain. After trying every cream, ointment and suppository on the market, I read numerous posts and changed courses this weekend. First, I ditched toilet paper and used only non-fragranced baby wipes even if I only went #1. I cleaned by patting/pressing the wipes up b/c to wipe hurt too bad. Second, I started sitz baths with Epsom salts in water as warm as tolerated which was terrific instant relief. Third, I began to apply coconut oil (it melts the moment you put your hands into it) to my bottom each and every time I went #1 and #2 -- so numerous times per day. I wore sanitary pads to protect clothing. Fourth, took Advil and even some Flexiril so I could finally sleep and relax. Finally, I began to take psyllium every day to bulk/soften my stool (I have IBS so I go TOO loose/often but psyllium works on both constipation and diarrhea like a charm which I know but am lazy about since it's not the easiest thing to get down).
I have to say that the combo of baths, baby wipes and generous/frequent lubing with the oil and psyllium brought me my first real relief.
Today, I had an appt w/an "anus" doc who prescribed diltiazem ointment which is thick/jelly like vaseline almost. I used a q-tip to apply it. My prescription says put around the anus but my doctor said "it doesn't have to go inside the anus, but if you can tolerate it you can put a little inside." He also gave me lidocaine for pain but honestly after my weekend w/psyllium, coconut oil and frequent sitz/cleansings my pain has gone from off-the-charts to tolerable so I'm not sure I need the lidocaine so will use "as needed."
I hope this information helps someone. I've never encountered such pain/itching as I have the last 2-4 weeks. I go back to doc for follow up in about 6 weeks. Hoping being diligent w/sitz baths, babywipes, regularity (actually drinking down my psyllium) and increased cooked vegetables will continue to help me heal in conjunction with the doc's cream. Good luck to all b/c this is a terrible condition!