Hi there. Thanks so much for all the help.

So I was prescribed 2% Diltiazem about 3 weeks ago. I take 1/2x 200mg magnesium each night as well as a small amount of lactulose. I then take Imodium during the day to try and keep to only one toilet visit in the morning and then not again until next morning. I have hot baths as often as I can. I use glycerol suppositories and wait 15-30 mins every morning to try and stay as soft as possible.

It seemed to help for two weeks and then (perhaps stupidly?) I tried a mild curry. The next morning I was straight back into pain and spasm. That was 4 days ago and I actually think now my spasm is worse than before I started Diltiazem when it had been getting better.

I did forget to take it twice (did once a day for two days by mistake) a week ago.

Questions: does my routine sound right? Should I try Macrogol/miralax/movicol as well/instead?

Should I just persist with Diltiazem even though I seem to have taken a backwards step?

Any other advice.

Thank you so much in advance!!!

Um, you shouldn't be taking imodium. If you're going too much then taper back your stool softeners.

Why not Imodium? I was going 3/4 times a day without which was making it all worse?

If you're going 3-4 times a day with softeners, then your dose is too high. Without softeners, that would be cause by something like IBS. Taking immodium on a regular basis may mess up the normal functioning of your colon. You're also risking your electrolyte balance by combining things this way. Try and observe what helps you go once or twice a day (at the most) without immodium, and stick to that routine. That may require facing the fear of a less than ideal bowel movement.

Hi. I have had IBS before. The pain of the fissure trumps anything else and is all I want to get rid of.

I’m doing glycerin suppositories every morning. Will putting them in (after Vaseline and lidocaine? Potentially be making them worse?

I’m no longer bleeding but definitely have pain most of the day. Should I be trying dilation?

I’m close to the point of just asking for Botox and then LIS. What I don’t get is why Diltiazem worked and then stopped. Should I try a stronger dose? I just do a pea sized amount. Is that too little?

Thanks so much.

Any thoughts on this guys? I’m wondering if I didn’t use enough Diltiazem?

I’ve stopped Imodium as suggested and have upped Diltiazem amount and also using iodine as that seems to help the itching. Have stopped narcotic pain killers too.

Any advice appreciated.

Glycerine suppositories are basically like soap for the anal canal, and can cause irritation if used on a daily basis. I would stop using them if you have soft enough BMs with softeners. Try using the diltiazem 20 minutes before you have a BM to help things relax. How many times a day was it prescribed to be used? A pea sized amount each time is fine, anything more will just find its way out and cause a rash.

It says 1inch on the finger applied on and around the anus. Should it just be in?

I’ve been on for 3 weeks now. It was so much better first week but has gone backwards a lot. What would peoples criteria for Botox be as next stage?

Healing a fissure often seems to be few steps forward and then it can go backwards again. I would just apply the ointment to where it causes least pain. It will be absorbed by the tissues after a while even if applied externally. I would always apply internally because that was less messy, and it felt fine to use a finger to apply.

Ointments are usually prescribed for 4-6 weeks before other measures are considered. You can ask your doctor their opinion on Botox, many don't recommend it, but others do.

Hi all when I have better days in a row, should I start trying to dilate? I have 18 and 20 dilatan kit. I’m at least 4 weeks post bleeding but less than a few days since really bad spasms.