Last Friday when I went to the CRS, she gave me a prescription for nitro cream, .2%. The pharmacy had to mix it up and when I got home I saw there was no info on how to use it and how much. So, I called that night and talked to the pharmacist. Oh yeah, there were finger cots in there and he said to just take a little bit on the finger cot and stick it up my rear. Well, I had no idea what a little bit was and he was no help, so I've just been guessing the past few days and really afraid to use too much at all.
I called the CRS office today and the nurse was surprised I wasn't given an applicator to use. She said she'd talk to the doctor about getting one and I stopped by the office this afternoon to get it. It's about a 4 inch long tube in grams. I asked her how much and she was vague, too. She started out by saying the whole tube which is 4 grams. Then, I said are you sure? She said well, maybe a little less would be better to start out. Maybe 2 grams, she said. Then, I asked her how far up the anus to go with this applicator. She said about halfway up the applicator, which would be about 2 inches.
I really don't know what I'm doing. If you've used the nitro cream at .2%, how much did your doctor tell you to use?
I mean I was just sticking my pinkie in the tub of cream and barely covering the finger cot the past few days. And I sure wasn't feeling any better, still bleeding and hurting.
But, I don't want to use too much either. I feel like nobody really knows what to tell me and I'm frustrated. They don't seem to want to ask the doctor for specifics.
I'm going back next Wednesday and can ask her then, but hoping someone here has used this stuff and can tell me what you were told to do.

I was given 0.4% GTNwhich is available in UK ready mixed. It has clear instructions which say a 2.5cm (1 inch) squirt is the right dose. I cut the fingers off latex gloves & used them on my finger to dispense the ointment. It then says to insert the finger into the anal canal up to the first finger joint. Your cream is half the strength so I assume you could use twice this dose if you wanted.
I was happier using my finger (at least you feel you have some control about where you're poking) & it helped to stretch out all the tightness.
My instructions were to use it twice a day, but because I felt it helped before a BM & then I wanted to re-apply it after, I ended up applying half the dose (1/2 inch) 4 times a day.
Took about 7 weeks but I now have painfree BMs & no bleeding. But apparently I have lots of scar tissue inside the anus which is causing constant sphicter spasms. I've got some differnt cream now for that !
Good luck - I hope it works for you

I got no directions other than what was on the bottle, which was very very vague. someting liek use 2-4 times per day or as directed. So I got finger cots and took about a blueberry-sized dollup and applied it up as far as I could comfortably go. At first, I did this 4 x a day. with this amount and frequency, I notcied an effect the first day. I got a headache, but my arse stopped hurting. It was notably more relaxed. If it stings a little for about 5 mins, that is the nitro working.

i used a q-tip covered with the fingertip of a latex glove. i took about a blueberry sized amount, same as buttgirl. i just kind of stuck it up in there gently and rubbed it in the area where i thought the fissure was and above that. i never felt any sort of relief from nitro, so maybe i was using it the wrong way though. but a q-tip seemed to be a good "applicator"

I was using 2% Nitro . My CRS told me to use it outside inly, about less than inch long mount. It is readily absorbed by skin and is used as a topical patch for heart patients - so I guess if it works for them topically, it should work for the muscle that is just below the skin. It worked for me - it did get loose after application. You might experience small headache - don't worry - it is actually a sign that is working ; ). I was too long on Nitro trying to heal - so I got burning feeling around my anus and private parts as a reaction to Niro. So, don't use too much and too often. I wouldn't go over 4 times a day unless you pooped immediately after application.
Good luck !!!!!!!!!!!!!!

Thanks, everybody. I ended up calling the office and talking to the nurse again. I just said I couldn't remember what she had said to do and that I was sorry to bother her again. She said "you know, I..." like she was going to say "I really wasn't sure either" and then she said the doctor was right there and she'd ask her. Good thing she did. I'm supposed to put 1/2" of cream in the tube which is about 1/2 gram. Way less than the 4 or 2 grams she said earlier. And just to put the applicator in the very beginning of the anal canal and push in the cream. Boy, good thing I called. One of the side effects is low blood pressure and mine is already low. So, I don't know what would have happened if I hadn't called back.
Thanks for the info about the headache. I just had a little pressure from the small amount I was using, so it'll probably hurt pretty good tonight. I guess because the CRS is saying it isn't fissures, she just has me using it in the evening before bed if that morning I had a BM that hurt. Which of course, is every morning for me. So, I"ll be trying it out tonight. I didn't realize it could be used many times a day. And mine is such a low dose, she may up it if I'm still having trouble when I see her.
I'm going to have to learn how to get tough and ask lots of questions before I even leave the office. I just took for granted that the info would be with the prescription. And, of course, I got that hinky feeling today at the office when the nurse was telling me what to do, but it's so hard for me to stand up for myself and bug people to get answers.
Thanks for all the advice about how to use it and what to watch for. I would love to have one BM without hurting and bleeding! Maybe now that I'll be using the right dosage, it'll work. I'm hoping!

Well, last night when I used the proper amount of nitro cream, I got a pretty good headache. Not enough to cause to much bother though. Tonight, when I used it, it burned pretty good for about 5-10 minutes. Is that a normal reaction? I hate to call the doctor's office again if it's normal. I've been trying to find something on the net about it, but not coming up with much.

i got same reaction from nitro cream. it happens because nitro increase blood supply to the area and sometimes too much of that can cause pruritis. try using less of it, but if it becomes too uncomfortable ask for ca blocker cream. it also relaxes muscle but without those side-effects. also make sure that there is nothing else in the base of a cream that can be irritating.
call the office 100 times if needed- they are WELL payed to do their job and are there to help you.
all the best,
; )

I was allergic to nitro and spent the night in extreme pain due to it my husband even called the emergency doctor in the middle of the night! I switched to diltiazem and was fine, and that works great for me.
Our doctors here know nothing about all these sort of problems-you have to clue-up on everything on here and then go and tell them their job!
Good luck!

I know that burning is a normal reaction but it was way too severe for me. I had to wash it off and could not use it anymore. Most people can handle it just fine but not everyone.