Jack, Thanks for your site, I've had the opportunity to view it over the years. I'm a 63 year-old male with a history of anal fissures for at least 20 years. I've had corticosteroids, various ointments, stool softeners, careful high fiber diet, metamucil, surgery--and you name it over the years. My surgeon says I'm the only person he's ever seen back after successful surgery. This was about three years after a very positive experience with the surgery, almost immediate relief and no problems thereafter until one day when I apparently changed my diet enough to start things again. This was relieved by steroids and metamucil. I was told to take the metamucil three times a day for life. That worked for another three years until on a trip when diet change again restarted things. This lasted for about six weeks when I finally sought care after totally vegetarian diet, colace three times daily plus metamucil three times daily didn't work.
I'm in a small town and am a retired dentist so I could talk to the local nurse practitioner and explain what I wanted to try. My Web searches had narrowed it down to nifedipine ointment. He gladly prescribed me a few 10 mg capsules--cost about $3--believe it or not. I used a small postal scale I have that measures in grams and added 30 mg of the capsule liquid obtained by sticking clean small sharp scissors into the three of the nifedipine capsules and mixing the sqeezed out liquid with a clean blade into 15 grams of clean petroleum jelly (0.2% concentration). Using finger cots I applied about a dime's worth of ointment three times daily to the external anal canal. I continued with my vegetarian diet, stool softener and metamucil for three days at which time the bleeding had stopped. I then gradually stopped the high vegetarian diet (still eating mostly veggies and fruit with some meats), stopped the stool softeners over the next three days, and am now only on the lifetime metamucil regimine. After twenty years of off and on problems with this I would say that the nifedipine ointment is the most miraculous "cure" I've ever found. No side effects whatsoever, cheap, and highly effective. So based upon my experience, I would highly suggest this as the first line of therapy, along with the other diet suggestions you have on your excellent site.
I would suggest one other item: Xylocaine 2% jelly. This is effective at relieving pain during an active fissure episode. Apply a small amount in the outer anal canal about 3 minutes before a movement. I've also found that it can be beneficial as a preventative. If you feel you are going to have a problematic hard movement--during a time without fissures--also apply the xylocaine ointment and let it wait for about 3-5 minutes. This appears to allow a less strained movement and can prevent retearing the canal.
Thanks for your site. I prefer to remain anonymous, especially as concerns my email, having had many problems with spam over the years. But you are free to post my story if you feel it might benefit folks.