Hi all- I am still having some issues 3 weeks post botox. When I saw the CRS for the first time and he suggested the botox, he also wanted me to go back on the Nifidepine. My GP had originally put me on that back in April and then suggested I use it again in June, so I used it for around 3 months in total prior to seeing the CRS. And I still had some of the second prescription left. When he heard that I had some left, he encouraged me to use what I had, even though he said he did not have his compounded with the cortisone. I had concerns about the long term use of cortisone , but he said just go ahead with what you have, while also giving me the new prescription. His script was different in two ways- he wanted me to use it 3 times a day rather than 2 and to put it up about 1 cm inside (which I hope I am doing- I'm scared of the Q-tip application he suggested- I don't feel like I can tell what I am doing and am scared of poking myself!). Anyway- I have begun to wonder if the cortisone has been bothering me, so I had his scipt filled today and his is in basically a vaseline like base. It is also .2% as opposed to .5% of the one I had before. So I am hopeful that some of the irritation I have been feeling may be due to the cream. I found it messy and irritating and so far the lubrication of the new one is much easier to handle. Anyway- I searched the site to see if anyone else had experiences with long term use of the cortisone base and didn't see much although I can certainly see that we are all a little confused about the external vs internal application and how to achieve that!

I assume it's hydrocortisone? Or does it actually specifically say something like cortisone acetate?
Either way it's a glucosteroid and generally shouldn't be used long term even though it's pretty weak as far as topical steroids go. Long term use can thin the skin (true for all topical steroids) and make problems like fissures worse. In the short term it may reduce symptoms like itching but personally I'd temper my expectations. A lot of us have used it early on in our fissure adventures (for some reason doctors love to go to it as the first catch-all measure for any kind of butt problem) without much success. I personally used it in a bunch of different forms -- by itself as a cream in various concentrations, compounded in with other ointments like nitroglycerin, as suppositories, etc. and it didn't do squat on the fissure front.
That having been said, I did suffer from hemorrhoids for a number of years before getting my fissure, and was rather liberal about slathering on tons of hydrocortisone cream during that time. Somewhat effective for hemorrhoids but no help at all for fissures would have to be my verdict.

Yes NG- it is hydrocortisone. I think it has been causing some of the itching and irritation on the outside as just switching to the petrolatum base today seems to have lessened some of that. My instincts from the beginning were to fill his prescription as I felt the CRS would know more than my GP. However, I have to say that in my search of the site today I read some of your earlier posts from when you were on your path and saw your experiences with the CRS who you had google the correct % of the other ointment. So who knows? But I am hopeful that stopping the HC is improving things somewhat. And the old HC based prescription was a higher amount of the Nifedipine- .5% as opposed to 2% on this new one.

Hey Bambi,
It could be either the base or the nifedipine concentration making the difference. Different people's skin react differently to the various ointments (I always found diltiazem to be irritating but some others find nifedipine to be irritating for instance) so it's not impossible that the lower concentration is simply gentler on you. I think most of the studies have used 0.2% or 0.3% nifedipine. I don't recall having seen any mention 0.5%. That doesn't mean it won't work, of course. Just means that's not the standard approach and there hasn't been much to indicate one way or the other how effective that is. So for better or worse, you're now on the path more well traveled.
Either way it's good to hear that the new ointment seems to be treating you better. Hopefully it plus the Botox helps you make some forward progress. If not, then you can always join the little wave of healing we've got going on with the recent LIS patients.
And yeah I did have some funny experiences when dealing with my fissure hahaha. I'm surprised you dug deep enough to find that little story. You must have been doing a lot of reading on the site :) But hey, all's well that ends well, I suppose.

Just curious NG- did you end up having your LIS with that CRS?

Haha nope. That one was about 60 miles from where I live so it wasn't real convenient anyhow. It was mostly a matter of me exploring every single avenue possible before finally pulling the trigger on LIS. I saw 5 different CRS before it was all said and done, and actually ended up getting LIS with one of the very first ones I saw.

Oh, I should add that the reason I did that is because the CRS I ended up getting LIS with, she suggested surgery the very first time I saw her, which was a few months after my fissure fun began. At that time I was thinking "no way!" and then proceeded to go through a bunch of additional creams plus Botox. Finally, after a year of fissure fun and being satisfied that I had gone to Shangri La and back in my search for a scalpel-less cure, I went back to her and requested surgery.

Oh, one more footnote: one of our very knowledgeable and very well respected long time board members did get LIS plus fissurectomy with the CRS you asked about, and was extremely pleased with the results. So we can definitely say that whether one knows the exact concentration of an ointment by memory may not necessarily have much bearing on one's surgical skill :)

That's good to know. I have found myself doubting my guy lately even though that's not really fair. I have thought about seeing someone else but then that will only prolong things all the more. I know exactly what you mean about needing to try everything under the sun- and from you guys who have been there it seems that the surgery is often necessary and a good thing in the end when it has been my worst fear for so long...But I'm the type of person anyway (as I suspect you are) that has to do that with many things in my life.

Yup definitely :) I always have to explore every nook and cranny to avoid the potential "what if" feelings afterward. If you would feel better seeking a second opinion, you should absolutely do it. It's your body, after all, and you shouldn't put your well being over some doctor 's feelings (believe me, there's no way any reasonable doctor would even feel hurt because a patient wanted a 2nd or 3rd or even 4th opinion). I think I know what point you're at right now based on my own experience. Surgery does work out nicely for most, but it's not something you should do until you're fully comfortable with it. As another board member here once told me, when the time is right for surgery, you'll be 100% eager to just hop right on the operating table. So only you'll know when the time is right :)