Can nitroglycerin make you bleed more?

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Can nitroglycerin make you bleed more?

Postby ruchgupt » 25 Aug 2023, 09:18

I'm in the midst of a bad retear and I've noticed that after applying nitro, some bowel movements my anal fissure will bleed so much it colors the bowl, versus other times it's just spotting in the wipe and in my stool. I do have BMs without blood in between too, so not sure what to make of it. Seeing that much blood in the bowl again is soooo disheartening.
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Re: Can nitroglycerin make you bleed more?

Postby Rich44 » 30 Aug 2023, 13:03

I am sorry to hear your issue is ongoing. Nitro is for anal pain as it relaxes your muscles so if you have a tear that is fresh, you will still see bleeding. Bleeding is not a side effect of nitro.

Keep in mind the National Institutes of Health said, "Topical nitroglycerin was only effective in approximately one-half of patients with an anal fissure. There was a very high incidence of adverse reactions. In our experience nitroglycerin more often causes a headache than treats the symptoms of anal fissure." In other words, you will likely have a bad headache with pain while the pain from the fissure may or may not remain. They also say you should not take nitro for a long time. But if you are tolerant of using it and you find you get pain relief then maybe it's ok for you to keep using.
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Re: Can nitroglycerin make you bleed more?

Postby ruchgupt » 31 Aug 2023, 18:29

Thanks, Rich44. It's really bad - I just keep retearing and am at a point now where I am worse than I was in June, rather than incrementally improving. Have a consult next week w my CRS and think he will suggest Botox or LIS if it's bad enough and I will likely accept it rather than trying to self heal. I guess I'm just worried about retearing w LIS - given my diet hasn't worked itself out yet, and I definitely have some kind of IBS.

Anyway, for the nitro point, it's been REALLY helpful for pain, which to me means it's at least working to relax the muscle enough for that, but maybe not enough to heal when I'm retraumatizing it. The headaches are minimal, so as long as my CRS says I can continue with it, I will - but it's not a fix-all for sure. There's some days nitro doesn't seem to work. So. Feeling very at a loss lately! Thanks for your sympathy and advice.
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Re: Can nitroglycerin make you bleed more?

Postby Hazey123 » 01 Sep 2023, 17:30

I’m sorry you are in pain ruchgupt, i can relate! I use nitro daily for the past year. It helps a bit I think altho sometimes it burns - but then the fissure burns too! Rich44 is it bad to use it long term?? My CRS says it’s fine. Did you see anything in the guidelines to say it shouldn’t be used long term?
It’s a miserable condition, I hope your CRS has some answers ruchgupt. I seem to be stuck in the no Botox no LIS department. Altho im not sure I could stand to do either procedure now… I’ve been like this for so long I can’t imagine recovering from any of these procedures! One day I hope I’ll wake up better. Each day im hopeful. It gets a tiny bit better I think as the months go by.
AF following skin tag surgery Feb 2022
GTN ointment
sigmoidoscopy & EUA Sept 2022 no fissure found
2nd opinion Jan 2023 fissure diagnosed, diltiazem - allergic
recommended Botox Fissurectomy
3rd opinion - dilation 2x per day plus GTN ….
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Re: Can nitroglycerin make you bleed more?

Postby ruchgupt » 04 Sep 2023, 06:38

Hazey, sorry you're also stuck. It really is a miserable condition! Every step forward for me comes with giant steps back - I think the real problem is getting my GI system right so I can actually heal, but I don't have a lot of faith in my doctor's guidance here, and everything I've done thus far has only worked a few days before going wonky again in terms of the right stool consistency. I'm just so tired of seeing blood in the bowl again, after two months of only small spotting and streaking here and there. Sigh.
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Re: Can nitroglycerin make you bleed more?

Postby Hazey123 » 04 Sep 2023, 17:09

Stool consistency is the main challenge! I found one sachet of Movicol split in half (one half lunch one half before bed) works best for me altho sometimes I only take half. Our bowels are very inconsistent I think naturally which you don’t care about when it doesn’t hurt. But once you have a fissure you do notice every little variation. I really thought getting this right would end my pain as I took fibogel for ages which was terrible for me (but it took me ages to realise!) but now all is soft and perfect I’m still sore. I don’t understand why I don’t heal!!! Grrrr one day it has to go away surely!
AF following skin tag surgery Feb 2022
GTN ointment
sigmoidoscopy & EUA Sept 2022 no fissure found
2nd opinion Jan 2023 fissure diagnosed, diltiazem - allergic
recommended Botox Fissurectomy
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Re: Can nitroglycerin make you bleed more?

Postby Rich44 » 13 Sep 2023, 17:19

Personally I don't like the thought of using any medication long term. Nitro is powerful stuff to being with. However, I am not the one to ask if it's ok to use long-term. You should ask a doctor or pharmacist.

I also am not a fan of Miralax or Movicol or anyting to soften your stool when you have AF. I feel it does more harm in the long run because your sphincter tightens up when your stool is too soft all the time and if it tightens up, the blood flow is restricted and if there is less blood flow the AF cannot heal properly. So my personal advice is ditch the stool softeners and laxatives. Try relaxation techniques instead when you have a BM.

I don't have the greatest diet, but I am close to a normal weight. What's crazy is my BMs are fairly consistent even without fiber or lots of veggies. My main issue is with trapped gas from high fiber foods, many vegetables, garlic, etc. So when I eat what I like to eat, I tend to feel pretty good. I was tested positive for SIBO (Small Intestinal Bacteria Overgrowth) and even though most people are ok to take probiotics, fiber and fish oil, all of those things kill my gut! I actually stopped taking probiotics and fiber (with my gastroenterologist's approval) and my gut felt WAY better plus BM's are pretty good. The human body is so weird!
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Re: Can nitroglycerin make you bleed more?

Postby ruchgupt » 21 Sep 2023, 18:16

Rich, so interesting. I'm with you on wanting to wean off the Miralax but my constipation is so bad off of it that I struggle to have normal, well-formed BMs that don't tear me - so right now the struggle is figuring out food/BMs. If I can get that right I'll feel so much better about surgergy. But as of right now, I feel aimless w my experimentation and my butt hurts so much that even one bad day of a failed experiment scares me! What tests did you get that led you to the SIBO discovery?
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