Although my CRS said the fissure had "healed" or scarred over I still experience pain all day - although nothing like before- I feel though it is just the fissure- not a spasm. It is like a small cut that is aching all day, so he put me on diltizam. My question though- Do i need to put it inside on the actual fissure? I tried but hurt so much worse all day. Is it still working if I just put it outide? Thanks
Tami

Hi Tami,
That's a question of some debate and different doctors of different members on this forum have given different advice. But since the diltiazem only works on the internal anal sphincter and doesn't have an effect on the external anal sphincter, it does seem like it needs to be applied internally to achieve the maximum effect, and after researching this pretty thoroughly in various places online, this is the general consensus out there among doctors and researchers. Not that much of the medication is absorbed in the bloodstream and it mostly works locally so you really have to get it applied on the muscle it is going to work on. That being said, if it is causing you too much pain to get it up inside you can try applying it just on the outside and as you get up and move around some of it could work its way up where it needs to be just by the action of the muscles themselves.