Welcome to Mayo Clinic Connect, @jette123. I have never had an anal fissure, but a good friend of mine did. Sounded really challenging and painful.

I'm sorry to hear about the pain and feeling like a bowel movement is difficult and hard to complete.

Tagging a few members who have talked about anal fissure for their support and any input they may have for you on this journey to get things working more ideally and get relief from pain @lisval @mikaylar @branmo @adlttl123 @ruth2019 @mimi86 @samclembeau. @rashida and @jlharsh also may have some thoughts for you.

How well are the ibuprofen and acetaminophen managing your pain?

Hello @jette123 - so sorry you are going through this! I can relate and, hopefully, some of what I outline below will be helpful...

I developed a fissure approximately 3 years ago – unknown to me at the time. Once I was correctly diagnosed (long story), it had become chronic. It was very painful during the day and subsided somewhat overnight. Getting to the right colorectal surgeon was the key to finally healing. It sounds like your second doctor is prescribing a similar approach with a few differences. I'll summarize what I used/did (both by Rx) as well as more holistic measures:

1. The fissure was finally diagnosed approximately 1 year after symptoms started. In that interim period, I saw my primary, a gastroenterologist, and my first colorectal surgeon – all of whom thought my pain was coming from a hemorrhoid. That sounds crazy, but I’ve since learned that fissures are misdiagnosed all the time. There are many reasons for this, which I won’t go into here.

2. It was not until I went to a second colorectal surgeon that I was diagnosed with a fissure. I was prescribed a compounded ointment with three components: hydrocortisone, nifedipine, and lidocaine. I applied it 2x per day for 8 weeks at which point I saw my physician again. By this time, my symptoms were much better and my physician indicated the fissure had healed. [You mentioned the Nifedipine in your post. My understanding is that it helps the muscle relax which should be helpful – at least, that was my experience.]

3. During the 8 weeks, I also used a therapeutic red-light panel 5 days per week for 10-15 minutes. I cannot scientifically prove it, but I believe it really helped w/healing.

4. I was left with some residual pelvic floor spasms supposedly set off by the chronic fissure. These were horrible, but pelvic floor physical therapy took care of those and today I am pain free and feel like I’m 98% back to normal.

5. You mentioned that BM’s are a problem and while you are likely already taking steps to keep things on the softer side, here is what worked best for me after much trial and error. I drink ¼ cup of aloe vera juice 2 to 3 times/day before each meal. I consume ten 8 oz. glasses of water/day. I also supplement with magnesium (a blend of magnesium oxide, malate, and glycinate) 2x per day – 1 capsule in the morning and 2 at bedtime. Magnesium citrate is also an option. I was already eating a Mediterranean, whole foods diet before this started and I did not make any changes to it. If you’ve not tried this before, look up recipes for Chia Seed Pudding. My physical therapist told me about it and suggested it could help with keeping things moving. She was right. On average, I have ¼ cup of the pudding each day. It is very easy to make and taste great too. That said, what works is unique to everyone! I may have veered off too far from the subject at hand, but I wanted to share given some of your comments.

6. If you’ve not already heard about/discovered Dr. Albert Chung’s YouTube channel, it is worth investigating. He calls himself “Your Friendly Proctologist” and really breaks things down into layman’s terms with a healthy dose of humor along the way. He has several short videos re: fissures that you might find encouraging and helpful. The link to his channel is: https://www.youtube.com/@yourfriendlyproctologist and you can also get there from his website: https://crsurgeryoc.com/ .

I apologize for the length of this post and it is likely TMI. However, if you have additional questions, feel free to private message me. I wish you the very best on your healing journey.