Nitroglycerine (NTG) is pretty "old school" because of the terrible headaches it causes. Most docs prescribe nifedipine now. Same action (increasing local blood flow), but less likely to cause headaches, and if it does, they are generally less severe.

The pain and spasms are due to the fissures, which are in the anal canal, not the rectal cuff.

Oral pain meds are pretty much of no use in this case. If you can get them, some people get good relief from B&O suppositories (belladonna and opium). They can be difficult to get and probably will need to be special ordered.

If this does not improve with the topical treatment, then the next step is Botox injections or even sphincterotomy. But, I'd go with the Botox first, as it does the same thing as sphincterotomy, without the results possibly being permanent (wears off in about 3 months).

Jan

Thanks Jan. I had already picked up the Nitro Bid before I read your comment. I decided to give it a try and boy do I agree with everyone. It burned like crazy! It helped that others had mentioned that it burned for 5 minutes and then stopped because that's exactly what it did. I also was very lightheaded and found that I need to lay down immediately after. But, when I went to have a bowel movement a few hours later, it was the first time in years that I wasn't in pain afterwards. I was so shocked. So, I used it again today and I'll do my best to deal with the nasty headaches. After my dr gets back into town I'll ask about the nifedipine and the B&O suppositories. Thanks again!