Advice on nifedipine application?

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Advice on nifedipine application?

Postby Darkeyes » 11 Apr 2013, 09:57

Another newbie here, I really appreciate this forum. I started with nifedipine/lidocaine ointment a week ago. I'm supposed to apply it internally twice a day. My CRS said to use a dime-sized amount and be sure my finger goes in about an inch.
The first time I used a finger cot on my index finger, that was very painful. Since then I've used my lubricated pinky finger (thanks to a suggestion from someone here) and that's less painful but it's still painful. Yesterday I just gave up and started applying it externally. I know there's been discussion here about the two methods and it seems different doctors recommend different techniques. The burning felt somewhat better yesterday but seemed back to its regular level today.
I spoke with my CRS specialist on the phone today. She said to apply it internally even if it's painful.
I've read on this forum about people using q-tips or applicators. I've thought about trying that but I don't want to make my problem any worse.
I'm just wondering if other people are experiencing the same issue? Does it get easier over time if the medication starts working? I'm just concerned that I'm traumatizing the fissure.
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Re: Advice on nifedipine application?

Postby suzyljank » 11 Apr 2013, 10:57

Hi, you don't have to get the nifedipine on the inside. It's purpose is to relax the sphincter muscle and applying it to the outside still relaxes the muscle. Your goal is to get the muscle to relax enough for the blood flow to return to the area so your fissure can heal. When I need to apply I use a q-tip, not the generics though because there isn't enough cotton on them. If you can get some inside it doesn't have to be very far up either but if it hurts you or you feel you are making things worse stick to the outside until things relax enough for you to try later in your course of treatment. If you are experiencing a lot of burning try some coconut oil, it's great, very soothing and chemical free. Positive thoughts sent your way, Suzy.
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Re: Advice on nifedipine application?

Postby CrackinUp » 11 Apr 2013, 12:00

@Darkeyes he is absolutely spot on for maximum effect. I did this and healed in 5 weeks... see success stories :)
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Re: Advice on nifedipine application?

Postby jr2 » 11 Apr 2013, 15:55

yeah,you really do want to get it inside so that it is applied to the internal anal sphincter where it needs to be. There is actually even a research paper that showed far better outcomes for healing when the ointment is applied internally than when it is just applied on the outside.
As far as application, I've always found a gloved finger to be best because there is "give" to the finger, and you can concentrate the pressure away from the fissure itself to avoid too much aggravation of the wound. A Q-tip was always too rigid and uncomfortable for me and I didn't like the idea of potentially leaving any cotton fibers in there to possibly attract bacteria.
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nifedipine help

Postby momof7 » 12 Apr 2013, 08:16

I'm on day 18 of nifedipine. It IS working for me. My CRS told me I could call him in 2 weeks to discuss other options if I didn't see improvement.
At one week, I couldn't tell a difference except for about three 30 minute periods that I didn't really realize I had a butt. Wow..."It might be working." Now, I'm on day three with only a few sporadic mild spasm episodes and two BM's with no 12-hour spasms after!!!!!
So, my CRS has me using the cream 4-5 times a day with instructions to continue when the spasms stop. Yesterday i had to remind myself. Now that is progress! also, CRS said I could use the cream the more often if I needed to. He said to apply internally, where the fissure is. NOT thr to "ring around the rosie" with the sphincter.
I'm down to a pea sized amount, maybe two peas, but not a dime...it gets wasted. Anyway, my fissure is posterior midline, s here is what works for my.
Right hand ring finger (next to pinky), trim nail way down. Apple nifedipine to pad of fingertip, reach around behind, using very tip top of finger, find center (between all my hemmies and other tags...). then applying gentle pressure to the anterior (part nearest front) slide finger in, rub with an up-and down motion rather than side to side. Wipe the finger with toilet paper to remove the vaseline feel. Then I wash my hands really well.
Now, After perfecting my "technique" I have also found that when I was still having hard BM's, I could use a little pressure to the anterior sphincter (reaching from the front instead of the rear) to help the BM pass, or place my finger in the posterior position to protect the fissure.
I don't use the cots. I just practice good hygiene before and after.
Adding Miralax to prevent constipation, and Metamucil for bulk (my BM's tend to be too soft unless I get const.) has helped sooo very much.
I was pain free the last two days, only slight discomfort. And I was so afraid I was going to be in torture forever!
Do get the cream inside. It doesn't hurt to also get in externally, especially if there are hemmies, but it should go on or as close to the sphincter as you can get it. Only 1/2 in does it.
If you have to, lie down in the hot bath, try to relax...even if the sphincter won't...get everything else as relaxed as possible, then turn to your left and apply medicine with right hand while in the tub.
Hang in there! It will get easier.
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Re: Advice on nifedipine application?

Postby Darkeyes » 12 Apr 2013, 20:26

Thanks for all the advice. I've had a couple of rough days with intense burning so it's great to have some encouragement. Fortunately my burning pain goes away late afternoon so I get some relief.
I'm back to applying the nifedipine internally. The past couple of applications have been less painful, only mild discomfort. Today it seemed like the medication was helping a bit but only for a short time. It's great to read your story crackinup. I appreciate all the details of how you apply the medication momof7, it's very helpful.
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Re: Advice on nifedipine application?

Postby Darkeyes » 10 May 2013, 16:41

Just an update on the nifedipine application. It definitely got easier on day 10 of using the nifedipine. I had some painful applications before then. I still have some mild discomfort sometimes but it's a lot better.
At my last visit (after 5 weeks on nifedipine) my CRS told me I had a little healing. I asked her what kind of lubricant to use when applying the nifedipine, since I had forgotten to ask her this at the first visit. She said I shouldn't need any lubricant. That sounds really painful to me. I've been lubricating my finger with the nifedipine since I was afraid vaseline might interfere with it. Thanks for all the advice!
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