Hi,

I just started on diltiazem this morning to treat a 3 year chronic fissure but it doesn't say on the tube how much or how many times a day I'm supposed to use it. The chemist doesn't know and my doc is away for a week. I used nitro 3 times a day and I guess that's what you do with diltiazem, but thought I'd ask anyway in case someone has a label on their tube!

Cheers.

Hi Phil! Have you looked into the possibility of LIS yet? Anyway, yes GTN/Nitro/Dializtem (whatever the spellings are) fall into the same category of ointments that improve blood flow to the area. So it is safe to use them up to 2 to 3 times a day and for up to 8 weeks. Hope you are doing better today!

Hi ButtQueen,
I've considered an LIS but I live in Germany and they seem to be very against cutting the muscle down there, because they don't know what will happen years down the track. The surgeon told me that in the US they like to cut but here they will avoid it at all costs. My other options are an 'anal dilation' under general anaesthetic or botox injections. I'm think of trying the anal dilation because I've read a few success stories with this procedure. But an LIS is really something I don't want to do unless there's no other option. But first I'll try the diltiazem!
Cheers.

Hi Phil,

I should imagine that three times a day would be fine. When I used it, I did not try to get it inside, but rather stuck to using it on the outside. This worked fine for me. 

Diltiazem is a calcium channel blocker and usually does not cause headaches. Personally I feel that if you have had your fissure for three years it will be difficult to heal with Diltiazam. It is usually prescribed for acute rather than chronic AFs. 

I imagine that what they use in Germany is Standardized Anal Dilation (S.A.D.) which worked well for one of our moderators (wecc). He had this done in NY, with great success. This is the link to his description of his recovery. Also, I am giving you a second link, to self-dilation, which a few of us have used:

my-standardized-anal-dilatation-this-morning-t4104.html
self-dilation-t4261.html

Feel free to ask any more questions you might have!

Hi Savaici,

Thanks for the links. I read a few posts about 'self dilation' which the surgeon mentioned to me as well. I'm definitely willing to give it a go - or at least allow a surgeon in Germany to do it. Apparently I have an extremely tight sphincter muscle and was destined for an anal fissure at some point; along with being very stressed when it happened.

I'm still going to apply the diltiazem 3 times a day for at least two months. I take a level teaspoon of Movicol every night and that works absolute wonders! These are things I haven't tried up until now. Before I was just using Rectogesic occasionally, and drinking lots of water. I only found out about stool softeners a few months ago. I knew about diltiazem but never tried it.

Did you try the self dilation? I find my butt is not so tight after sitting in a hot bath, and after about 20 minutes I try and insert a finger gently. I've already noticed a difference using the diltiazem today - not so much pressure down there. I'll apply it again before bed.

But I do feel more comfortable with the idea of having my butt stretched open rather than an LIS.. I guess they would do that for me in Germany too but I will try everything else first. Either way I don't want to deal with a fissure for 4 years, so this year I'm determined to heal this thing!

Cheers.