Hi all. Quick question. I went to a GI doctor on Jun 8th and he said he saw a major fissure in the posterior position. He did an anoscopy and digital exam. He prescribed me .125 percent Nitroglycerin three x a day. The nitro has helped a LOT w pain and healing even tho I have retorn twice bc of an occasional bad BM. Today I went to a nearby CRS bc the GI doctor was two hours away and I needed someone specialized and close. He only did a visual exam and palpated around the sphincter/butt and asked if the area he pressed caused pain - it didn’t hurt so much as it felt very sensitive but he said that was the fissure and he could see it. He said it didn’t look that bad and that he’d prefer I take nifedipine .2 percent with lidocaine 3x a day bc it’s stronger than the current nitro I have and with less side effects. He also said if it doesn’t improve in 8 weeks to come back and we’d look at Botox.

What questions should I follow up w him about?
Do you think nitro is better than nifedipine esp if it’s working? I’m nervous to switch?
If it’s not “that bad” why switch to a stronger prescription?

I’m just working myself up a little about whether I need to get a second opinion but would love to hear thoughts from the group and advice.

When it comes to the anal area I would listen to a CRS before a GI doctor. While both are trained in disorders of the digestive system GI doctors do not perform surgeries plus the anal area is the CRS area of expertise.

As to what questions you should ask - ASK EVERYTHING you can think of. Make a long list before you go in. Don't be one of these quiet, nodding your head, intimidated "good" patients that say very little and then do nothing but complain about the doctor when they get home. Be a vocal, inquisitive, very concerned "responsible" patient (like me!). Challenge their knowledge; after all they may not be the right CRS for you. You are suffering and need relief now. These CRS are specialists and cost a lot of money (that you may be paying for) and you have every right to ask anything you like.

Definitely get a second opinion from another CRS as you seem to want a third treatment "tiebreaker" here.

I second Rich44's suggestion. But I would personally go with the nifedipine because it doesn't cause the headaches that nitro does.

Thank you both! Rich, I did ask a LOT of my clarifying questions and finally learned I have a sentinel pile too! That was helpful to learn. I do think I’m going to ask if it’s possible to stay on the nitro but up the dosage as I’m nervous about switching ointments - the nitro really has been a lifesaver and I do not often get headaches! If he insists on changing the course of treatment I’ll go along with it but I hope he’ll work with me.

ruchgupt wrote:Thank you both! Rich, I did ask a LOT of my clarifying questions and finally learned I have a sentinel pile too! That was helpful to learn. I do think I’m going to ask if it’s possible to stay on the nitro but up the dosage as I’m nervous about switching ointments - the nitro really has been a lifesaver and I do not often get headaches! If he insists on changing the course of treatment I’ll go along with it but I hope he’ll work with me.

Sounds good! Best of luck!