Yesterday morning when I went to the bathroom I experienced that razor sharp pain and intense burning that others have described. It was so unbearable! I dread every bm. Today I got into the doctor. He prescribed Diltiazem 3x/day. It says to apply topically to anal canal. My question is "how far do I need to go in?" He also gave me Lidocaine ointment for use in between the med application. He prescribed Flagyl for a possible inflammation/infection that he noted as well. How soon will I get relief? Thanks!

Hi Gracie,

I've never used Dilitiazem so I'm not sure how it works, but I'm assuming it's applied the same way as nitroglycerine. Using a gloved finger I would try to put the medication as far up into your anal canal as is possible. This way it will get to the affected area. Use the Lidocaine first and wait 5 minutes before applying the Dilitiazem.

I would also prescribe hot soaks in the bath. This really helped to sooth things for me with my fissures. Sitting on a heating pad can also help. The other trick I used to use was to apply a really cold washcloth (wrap some ice in it) just after one of those burning bowel movements. It helped to take the throbbing away.

Be warned though that fissures can take a while to heal so even if you think it feels better don't stop using the ointment/cream until at least a week after you think it's better.

I hope you feel some relief soon. I know just how painful fissures can be.

Take care and keep us posted.

Shell

Thanks for the advice. I need to get some gloves. I am feeling kinda gassy and crampy today. I think because I am holding back using the restroom and emptying my pouch because of the pain.

hey,
i have my first one too it sucks!!!! i don't know whether to eat foods that thicken or thin things....i have been avoiding food because bm's hurt so much but then i end up getting up every hour during the night with liquid movements it's sooo irritated ....

anyways, my doctor gave me the lidocaine gel too, but he gave me proctofoam to put on the fissure...(steroid foam) -
anyone else use this???

should i have nitroglycerin cream or watever that is instead?? he never said how many days to use the foam for either :S i am confused.

does your fissure bleed a lot?
how long is a long time to heal?
how do i avoid this again?
wat is dilitiazem?

sorry for so many q's maybe i should have started a new topic lol...

Niki,
I think you want soft stools so that you don't have to strain--but not diarrhea cuz it burns! I have been watching what I eat carefully but I still have no relief. Mine does not bleed much, maybe some spotting on the toilet paper. My doctor said mine is acute and should heal in 1-2 weeks. But he said to continue the diltiazem for an additional 4 weeks. It is actually a blood pressure medication that is compounded into an ointment. It is supposed to help the sphincter muscle so the tear can heal. I don't know how it can be avoided other than not straining (which I don't think I do). If you figure out how please share. This is horrible. I hope you get some relief soon.

Hi,

First I should say I am so sorry that you are having such a terrible time. I had had a fissure about 4 months ago, it was so frustrating! It took me over 2 months to get it healed completely. Not that yours will take that long, it just took me along time to find the right meds to use. I saw blood only during bm's and then experienced extreme pain.

I did the hot baths alot and the heating pad. I used the lidocaine and it seemed to help alittle, It numbs somewhat. I tried the proctofoam and saw no change. Also the dilitiazem and no change. I finally was given the nitroglycerin and saw improvement in 4 days. It does give you a terrible headache but it was worth it.

I tried every over the counter thing out there also. Do a search on here for fissures and you will find all kind of help. Thats what saved my life. Everyone seems to be different and what works for one doesn't work for another so don't give up. Try everything! I was at the point of surgery and I was told by everyone here that should be your last resort.

Good luck and I hope that you both are feeling better soon.
God Bless,
Jessica Mahaffey

thanks jessica...and gracie, i talked to my surgeon and he told me to try to thicken up the stool a lot and even take immodium or lomotil a few times a day. i told him i was worried it would hurt to pass stool that was too formed and he said not to worry-- i guess with a j-pouch it cant get that firm exactly....so im going to take his advice and try to cut down on the trips to the bathroom!
he wont give me nitroglycerin yet tho...i asked him about it and since it causes headaches he wants me to keep using proctofoam..i've taken that for 5 days now and it is not much better.
the biggest problem i am having is that the fissure is causing so much irritation and muscle spams that i get up every hour or two at night and feel like i have to go to the bathroom....i hope the immodium or lomotil helps--i will try that tonight.
and here is a tip- dont eat a bunch of pizza lol..im an idiot and i had a very rough time on sunday night. i am weak and pizza is so good tho.....no more fatty foods for me or i really get no sleep at all.
hope youre doing better!
~niki

Niki, why won't your surgeon prescribe the nitroglycerine? That was the first line of action by my surgeon when I had my first fissure while in hospital for my takedown. Yes, it causes headaches but they are short-lived and not worth taking a pain pill for.

The nitro was the only thing that ever helped my fissures (and I suffered constantly with them when I had my j-pouch) so I just don't understand your doctor's caution with prescribing it.

I hope you feel better soon.

Take care.

Shell

hi shell,
i wish he would just prescribe it cuz i was up all night again i dont see him until feb. 5th now cuz he is going away he said it is too soon to tell if the proctofoam will work and he just said nitroglycerine has side effects so he doesnt like it--- maybe there is some other risk to using it???? all i know is that every time i use the bathroom i cant help but think that a headache for a few days would be better than this and i get mad. my surgeon has a habit of not fully explaining things even tho he is usually right so maybe he isnt telling me something...i dunno :S i dont really wanna go over his head and see my specialist about this but....

Niki, the headache only lasted for about 10 minutes after I had applied the nitro. It's caused by a sudden increase in blood flow, which in topical form increases the blood flow to the area where the fissure is and relaxes the anal muscles which in turn reduses spasming so speeding up the healing process. It's the same drug as is used for people who suffer from angina (GTN), so I suppose if you have heart problems it might be contraindicative but I can't think of any other side effect it might have.

Here's a very informative link to treating fissures with GTN (nitroglycerine):

http://www.addenbrookes.org.uk/serv/clin/surg/colorecta...l_faqs/fissure1.html

And here's another one that discusses causes and treatments:

http://hcd2.bupa.co.uk/fact_sheets/mosby_factsheets/Ana...ure_and_fistula.html


Good luck.

Shell

Thanks for all of the advice. I would say I have improved quite a bit since my first post because I am no longer screaming when I'm on the toilet. It still burns though but hopefully that will subside as well. It also sounds like the DermaWheat product has helped many. If I continue to have problems I may try that.

thats good to hear gracie
i wish i could say the same tho, i have been using this foam stuff for about a week and it still hurts. it is really hard cuz im in school again now and i have to sit thru 3 hour classes, and a one hour drive.......i went to the washroom 2 times at school and i thought i was going to die on the car ride home....and the problem is i dont have a sitz bath i can take to the public washroom to soothe me after i go.....i dont know wat to dooooo bah. sorry, im just frustrated...
wats dermawheat?

Niki,
I am sorry to hear that you are in so much pain. It would be hard to deal with in school on top of that. Hang in there--I'm sure something will work. I have not tried DermaWheat Cream, but if you do a search on this site you will see positive reactions to it. Their website is www.grassfactor.com. There are many testimonials which show it's quick at healing fissures. It is a natural product and may be worth a try. I've never had a sitz bath. I do carry my own wet wipes with me so I can clean myself gently in public restrooms. I am thankful that at my work our staff restrooms are single rooms with more privacy, not stalls. I'm sure everyone wonders why I spend so much time in there

I pick up my lidocaine/diltiazem compounded Rx tomorrow! I am trying to think positive thoughts, as I have been enduring my fissure for over 4 years. I am a little fearful of the nitro head-aches, as I do not need to add another trigger for migraines. . . but I really want to get my life back. . . without the constant companion of fissure pain.

I, too, was wondering how to apply it, but the gloved finger sounds about right. I have been self-dilating for about 4-6 weeks now, but still get spasms, so I hope this helps.

I also use a combination of 1/2 a vicodin and a hit of medical marijuana, and that has had some effect on helping with the spasms. Can't treat it if you can't get in there! I have been blessed that my gastro is willing to try alternative treatments and was open-minded to m/m.