At a loss... (I'm a pharmacist)

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At a loss... (I'm a pharmacist)

Postby trying2bbetter » 22 Mar 2012, 01:18

I am about 99% sure the pain I am experiencing is an anal fissure and having worked the last 7 years in a pharmacy, you name the treatment and I've met a patient who has tried it. That being said, there are certain circumstances that prevent me from being properly diagnosed and treated. My pain and discomfort is essentially my own fault as my suspected fissure is a result of an almost defeated eating disorder. My dilemma is that I'm still in rehab for another 2 weeks with only a the daily therapist and once weekly NP, who essentially just verifies we are on the "right" path, for consultation I'm at a loss of how to handle my situation. Forget laxatives, forget stool softeners, and forget trying to avoid certain foods. None of that is allowed here. Same goes for any medication, only pre-existing medications can be handed out during the four designated times. I should also mention water intake is monitored, recorded and restricted at certain times, because yes, there are girls here who will use it to manipulate their weigh-ins. Another factor working against me is allergies, I am deathly allergic to Acetaminophen (so there go your top prescribed pain meds) as well as Palm, i.e. coconut. Does anyone have any suggestions as to some type of temporary treatment? There is some bleeding during BMs, but nothing severe, and the pain is moderate. What I find most unbearable is the pain that occurs about an hour or two post BM & the itching that follows. (onset about 6-8 hours post BM) This has been going on for about 3 weeks now and what started out as tedious has turned into excruciating. And as far as the creams/ointments go, what seams to be the best, Diltalizem, Nifedipine or Nitroglycerin? Vaso-dialators increase blood flow yes, but the antiepiletic factor of the CCB (calcium channel blocker) stops the spasms, which is better? Also has anyone tried the rectal rockets? (lidocaine & nifedipine in a suppository) If I ask the NP for anything I basically have one shot and seriously need to make it count. Any input would be helpful, and I'd be happy to answer any pharmacy questions anyone has. Thank you.
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Re: At a loss... (I'm a pharmacist)

Postby workingonit » 22 Mar 2012, 10:41

Hi tb,
I would recommend nifedipine. It has the least likelyhood of side effects and your body won't become accustomed to it like it will to nitroglycerin. It does increase blood flow. In fact I had to stop taking it as my periods got way too heavy. It won't do much for spasms though. The best for that would be sitz baths and/or and electric heating pad. There is also self dilation to help for spasms. (see the ongoing topic 'self dilation' for more info).
I don't know about suppositories. I would think application of it with your little finger or a qtip would be more accurate. Some people have reactions to lidocaine.
Most people get 3-4% nifedpine. I would also recommend getting it in something other than a petroleum jelly base as petroleum jelly can mess with your ph balance.
Stay away from hydrocortisones. IMO. you probably know that already. They thin the skin after prolonged use and I have yet to hear of someone with a fissure healing with their help.
ibuprofen works better than acetominophen for fissures anyways.
Are your BMs soft?
You are sure they won't let you take a wee bit of miralax in the evening? I don't do miralax myself, but most people here who do softeners would choose it over ducolase.
I do metamucil and prune juice to help soften my BMs, but I don't tend towards consitipation.
So sorry to hear you are in pain on top of everything else you are dealing with!
That's great that you have almost taken control of your eating disorder! That is quite an accomplishment!
-Tanya
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