Does anyone have any experience with GTN cream and breastfeeding?

My situation: Gave birth in August, I'm now 5 months in with my fissure (caused due to breastfeeding constipation), after a recent rectoscopy I've increased my lactulose from 15ml once per day to 30ml 3 x per day, and I am continuing to use lidocain numbing gel daily (used since November)

I'm still experiencing light bleeding every couple of bm's (this is a huge improvement to the initial heavy bleeding everyday) also I still have enough pain to make it difficult to relax, I continue to spasm despite my best attempts to breath. The stool tips remain hard, once they are past the rest of the stool is soft, quick and ok to pass.

Ultimately the fissure not healing with just lactulose. The Doctor said the next stage is to use GTN to force the muscle to relax, however he insisted due to lack of research I would have to stop breastfeeding if I use GTN cream.
I had intended to continue breastfeeding my baby until 1 year but I also need to heal ASAP as I am returning to work next month and cannot deal with this issue any longer.

Do I have to admit defeat and put my health before my desire to continue breastfeeding? Or do I risk my baby, and continue to breastfeed whilst trying the GTN cream?

The doctor did say the 3rd step is botox, and he would not do this if I was still breastfeeding anyway.

Thanks

It's a tough decision no doubt. I found some related information on this old thread topic2876.html. It looks like GTN is safe to use while breastfeeding. I think a pharmacist would be a reliable source of information on this.

Thank you for sharing this thread. I will take a look :)

I used Diltiazem cream while breastfeeding. I think it's an alternative to GTN and very effective. My baby didn't have any issues with it. My doctor also said Botox would be fine while breastfeeding although I had finished breastfeeding by the time I had that procedure. It's crazy how different doctors tell you different things, but I'd definitely ask about Diltiazem if you can, it helped me get past some severe fissure pain.

Thanks for your comment Allthepain2.

If you don't mind I have some questions, did you get the fissure due to breastfeeding/birth too? I am presuming the Diltiazem cream helped with the pain, but didn't work enough to heal you. How long did you try it for? Did the botox work for you?

Yes, I got the fissure the first time due to breastfeeding constipation. It actually went away in a few weeks the first time, but after my second child, I've never been able to truly heal it. That being said, after my third child I was in extreme pain from the fissure when they prescribed me Diltiazem. In a few days with the cream (and taking Miralax), the pain was gone. As long as I kept taking the Miralax, I didn't have any pain. I went months with just the Miralax and only one ore two minor retears.

However, any time I tried to stop Miralax, it would retear so I decided to try Botox. So far that has been a complete bust. The procedure completely reopened my fissure and I'm back to my original pain (it's only been a week but it hasn't improved). I'm going to start using the Diltiazem and Miralax again since that seems to be what works. I'm still trying to figure out a long term plan. It's likely either Miralax for life or LIS, but my doctor is really against LIS on females.

I hope some of that information helps! Since you've had your fissure for months as opposed to years, I think there's a good chance the Diltiazem will help you to permanently heal. I took that for a few weeks and then stayed on Miralax. With that routine, I was able to make it to a year and a half of breastfeeding. Good luck!

Thank you! I am so happy to hear you went on to have 2 more children. Right now I have gotten to the point I crossed out the option of having another child through fear that I will have to go through this again (if I ever heal)

I guess I am a little afraid of the diltiazem increasing my pain during a bm (with the lack of control) and also that it might not work for me. I understand it works by relaxing the muscle to aid blood flow. Besides the 10-20 minutes during the bm, I don't feel that the muscle is tense any other time so I don't get why it isn't healing in the 23hours and 40 minutes each day that I'm not on the toilet (haha!) but maybe I am misunderstanding how it works.

Don't be afraid of the Diltiazem! It technically loosens the muscle, but I never felt like I had a lack of control. I could still "go" as slowly or quickly as needed. I didn't notice any super obvious difference other than having fewer spasms and then finally less pain with BMs.

As for having more children, I think that once you've healed some, you will know to be prepared when pregnant or breastfeeding. I had never even thought about the possibility of a fissure when I was breastfeeding and was completely blindsided by the severe constipation and then subsequent fissure.

After it "healed" from my first child, it didn't retear again until I was nursing for the second time, but I wasn't taking stool softeners like I should have been. So if you take preventative measures when you know you're likely to be constipated, hopefully it will help!

Do you have a skin tag or anything? I developed one pretty quickly and I'm wondering if that's affecting the healing. Hopefully you're still early enough in the game to be healed with just the cream. Let me know how it goes!

This is really promising to hear. Thank you

I totally agree about being blindsided by this unknown breastfeeding side affect. I feel like the hospital and midwives gave me so much amazing guidance on breastfeeding yet no one mentioned anything about this, I think it needs to be added to their information fact sheets as it could really help to reduce the amount of us who suffer.

Yes, how strange! I developed a skin tag about 1 month ago, it started as a tiny little bump and within a month its become a full size tag. Is this also common to get with fissures? Do they ever go away, or is it something that has to be removed (if requested by us)

I agree that it should be mentioned somewhere too. I had no idea what was even going on at first because I'd never even heard of a fissure! It's not likely to be something that people tell each other about either so it really just feels like something we suffer with alone. My husband knows about it, but I'm pretty sure he hates hearing me complain about my butt all the time haha.

As for the skin tag, I know they're common with chronic fissures, but I'm not sure if everyone gets them. Unfortunately, I don't think they go away once they develop. I'll likely leave mine alone though because a lot of people have said that getting it removed is worse than just leaving it alone.

Keep us updated. Hopefully the cream will be all you need!