Hi there. I'm new to the forum, but have been lurking for a while. I just have a question about Diltiazem and healing.
How long does it typically take for a fissure to heal with Diltiazem? I have been taking it for four weeks now, but still have pain on and off. It’s not excruciating pain and it’s not constant, but it still hurts a bit (I’m not sure if it’s the spasm or just the cut hurting itself... it's like I can feel the cut in there). I don’t have any bleeding (I actually never did… I know it’s a very common symptom of a fissure, but I’ve only had pain and irritation). I just want to make sure I’m actually healing and that the Diltiazem is helping. I believe I still have another couple of weeks or so on it. My CRS said to take it for 6-8 weeks.
I guess I’m just getting impatient because I want to be better soon and I want to avoid surgery at all costs, if possible (I don’t have health insurance right now). I don't have any issues with chronic constipation, so I've just been eating my normal diet (which is healthy with lots of grains, fruits and veggies because I also have acid reflux issues and am limited in what I can eat anyway). I think loose stools and major stress may have caused my fissure (which suddenly got MUCH worse during Christmas day, of all days... the pain was so bad that I almost went to the ER on two occasions). I saw a board-certified CRS last month and he looked at me, but didn't see a fissure on the outside, although he noticed my anus was very tight. He said I had all the classic fissure symptoms and said it was internal (the pain I feel is internal), but he couldn't do an anoscope exam because I was in too much pain and he didn't want to disturb the fissure. So he prescribed me Diltiazem, which seems to help loosen things up, but some pain remains.
I think I'm getting better and want to remain hopeful, but some days I get frustrated because this thing is so slow to heal and I can't do activities I once enjoyed. I just hope the Diltiazem is helping me.
Thanks everyone! :) I really appreciate any help and am so happy there's a forum like this around to help everyone with this horrible issue.

I've been on Dilt. for 10 days now. There has been no real change in my pain level. I think maybe I'm a little better, but not enough that I can say with confidence that there has been any improvement. I'm curious about how long it took you until you started to feel like the pain isn't excruciating, or started to go back and forth. I would love to describe my pain this way.
Right now, its predictably awful everyday. There's the original raw pain of the BM, and then, a few hours later, I start to get throbbing, sharp pains in my pelvic muscles, and the fissure area starts to itch intensely. (Cocoabutter suppositories helps with that last symptom.)
If I'm going to end up needing surgery, I want to get it over with already!

Hi coconut,
I'm sorry to hear about your awful pain. : ( This really is a challenge. My CRS said it would take 2-3 weeks to notice any difference from the Diltiazem. I noticed some difference in about two weeks, so it takes time to start working fully. Honestly, though, I'm not sure how much good it's doing for me or if I'm just getting better on my own. It's hard to tell in my case because the pain is still there, but it's on and off. I suggest sticking with it for at least 2-3 weeks and see how you do. If it doesn't seem to have any effect, consult your CRS about it and maybe you can try something else that will work better for you (I know there are some other ointments you can try).
I know some people stay on Diltiazem for months and I really don't want to do that if it's not necessary (I don't want to develop an allergic reaction or hypersensitivity to it like some people after prolonged use). Should I keep taking it if the pain isn't completely gone yet? If anyone out there has healed with Diltiazem, how long did it take? Weeks? Months? I'd love to know. I know I have 2-4 more weeks on it and it's a slow process, but I still want to know what other peoples' experiences were/are with it.

Thanks for the info about 2-3 weeks. I haven't had a full two weeks yet, so maybe I'll start feeling better soon.
I've been on these forums for a while and read a lot of old stuff. It seems that the consensus is that yes, you need to stay on the medicine and keep babying your butt for a good long time after the symptoms stop. If you fissure isn't chronic, then it might only be a few months, but people with chronic fissures keep the cream going for months and the diet going to some degree for life.
Generally, people who let up before all the symptoms are long gone experience a relapse. Now remember, the folks who find their way to these boards are severe cases. I had a fissure years ago, treated it with baths and diet alone, and went about my merry way, never knowing that this forum existed. So maybe you'll be one of the lucky one's who heals more completely and quickly than others.

Thank you for the information, coconut. Yeah, I guess I just have to keep up everything (healthy diet and Diltiazem) until I'm positive that I'm healed. I still have about 2-4 more weeks on the Diltiazem. I've read most people stay on it for at least 8 weeks, so I will continue to use it until then just to be safe. I REALLY don't want a relapse. The super-healthy diet gets a bit old sometimes, but I have to do it anyway (I have acid reflux that has been flaring lately). Just need to remain optimistic, which is in some ways the hardest part of this for me.

It took five months for my major fissure to heal with Diltiazem. The fissure was about a centimetre long and down to the muscle in depth. I stopped using Diltiazem ultimately because I developed an allergy to it, but it did help with relaxing the muscles.
However, once my fissure had healed, that wasn't the end of the problem. My anal muscle tone by that time was so tight that I was developing minor fissures with most bowel movements and still getting muscle spasms in response, so I was still experiencing pain. Ultimately the LIS operation fixed all that and I'm back to normal now.
However I don't think I fit the typical profile of someone who heals with Diltiazem, so don't be too discouraged on reading this post! The CRS who performed the LIS told me that when all the studies for all of the creams which relax muscle tone are taken into account, they're effective for about 50% of people. Individual studies for one cream or another may show higher success rates, but a meta analysis apparently puts the success rate for creams at around 50%. He also said that if Diltiazem hasn't worked within 6 to 12 weeks, it's unlikely to do so (it was a previous surgeon who left me using it for 5 months, until I developed an allergy to it).
I think coconut is right, and that people who heal within 6 to 12 weeks using Diltiazem are unlikely to seek out a forum such as this one. I know two people who have only ever developed one anal fissure in their lives and healed using just Lidocaine to deal with the pain and a change of diet. One took 2 weeks to heal and the other 10 weeks. The fact that your pain seems at quite a manageable level and is intermittent seems like a very good sign to me!

Thank you Lauren12 for the information. :) I will just stay on Diltiazem until I'm confident I'm healed. 6-12 weeks sounds about right. Different sources online say different things about how long to stay on it (one said 4 weeks, while others say 6-8 weeks), so it gets confusing. I guess I can always call my CRS if I'm unsure when to stop it.
Did you get a rash or really bad itching when you were on it that long? That is one of my concerns about taking it too long. I mainly just have slight burning when applying it, but that's about it.
I'm sorry you had to eventually get the surgery, but I'm glad it helped you. I'd prefer to avoid surgery if possible (I don't have health insurance right now and it seems like a last resort type option), so I'm doing everything I can to heal it with diet, stress reduction, and the Diltiazem.
I don't know how large my fissure is since my CRS couldn't check inside (where the pain is coming from) because my pain level was too much at the time and he didn't want to disturb it. I've heard even small fissures can hurt a ton, though. I've never had any bleeding, so I guess that's a good sign.
The pain is tapering off, although some days are worse than others. I'm just really, really afraid of experiencing the pain that I had when this first happened (it was excruciating pain that I wouldn't wish on my worst enemy). It ruined my entire Christmas. If I had pain like that every day, I would most definitely opt for the surgery. But since the pain is tapering off, I'm hopeful that it's getting better with the Diltiazem and healthy diet.

It does sound really good that your pain is tapering off, having started out being excruciating. That sounds like a really rapid recovery rate to me. My pain was also excruciating when I first developed the fissure but didn't tail off like yours, it only reduced gradually and as I mentioned, when after 5 months the CRS told me the fissure was tiny and just a "dip" rather than a fissure (in other words just about healed), I was still getting pain from muscle spasm and a high muscle tone was leading to minor fissures with most bowel movements. They were the type of minor injury that wouldn't have bothered anyone with a normal anus, but I was still getting muscle spasms. So I wasn't sorry to have the LIS - I was pleased as it sorted everything out! I'd have had it sooner if I could, but in the UK, they try conservative methods first and only if these fail they go on to try Botox, and then the LIS.
Anyway, as I say, I think I'm an unusual case because for most people, when their fissures heal, they no longer have any pain. I was one of the few that needed the LIS even though I no longer had an active major fissure.
The fact your pain is tapering off and is intermittent sounds like a really good sign.
When I became allergic to Diltiazem I developed a rash, which itched. Somewhere on this forum there's a thread called 'The Diltiazem Itch' where people have posted their experiences of an allergy, so don't worry, if you develop an allergy to it, you'll know about it! The surgeon did give me a cream to get rid of the rash however, plus I had to use a non-bio washing liquid to wash underwear and not use fabric conditioner. The rash subsided quite quickly. I had to give up using Diltiazem however. I don't remember slight burning when applying it however, but if you're not bothered at any other time, I'd guess it was OK.

I'm on day 13 and this is a good day! Its not pain-free but the pain level I'm experiencing is manageable, and that's without advil or similar pain relievers. I'm hoping that this will be the start of a trend towards healing. Woot!

That's great, coconut! I'm glad it seems to be helping. Just give it some time and see how it goes. I really hope you find complete relief and healing with it!