Some of you may have read the post I made in the General Anal Fissure Discussion. The surgeon I saw today (not a Colorectal surgeon, just a general one) gave me ditiazem to use 3 times a day. Thank God - a cream that may help HEAL my problem, not just make me numb and cover up the pain!
I'm just a bit iffy on how exactly to use the cream. I know it can be used both internally and externally, and you're only supposed to use a small amount (pea-sized?), correct? But how exactly do I know I'm putting it directly on the fissure?! The fissure is internal - it can't even be seen externally. The pharmacist said I could try using a q-tip to apply it directly to the fissure, but it's hard to tell exactly where it IS! I know it's around the 4:00 position, but I can't guarantee I'm getting the cream on it when it's internal... I do have a small applicator that came with the hydrocortisone cream I was given a few weeks ago. Should I use that? The only problem with the applicator is the little holes are all around it, and I'd be putting cream on the whole rectal area...is that bad? Should it only be applied to the fissure?
Also, how long do you use the ditiazem? The surgeon said a couple of weeks, but I know others here mentioned using them for a matter of months! What did your doctors tell you? This surgeon wasn't a colorectal surgeon (the only colorectal surgeon at the office didn't have an appointment until July), so I'm thankful he was able to prescribe the right cream for me, but he wasn't very clear on how, and how long, to use it. He's not really an expert on treating them. Anyone have some advice?

Hi,
I just finished my 8th week of using ditiazem and evolved a method of using it during this time. Pea-sized is the correct amount. It needs to go inside. I use the small applicator which came with my hydrocortisone cream also, but that was my own idea as they gave me about a 2 inch applicator with the cream which did not work so well for me and felt uncomfortable. I think you need to get it in about 1 cm. I measured my applicator with a ruler, and my applicator is about that size. Another rule of thumb (or should I say finger!) is to get it into the first knuckle of your pinky finger. What I do now and have been doing for a couple of weeks is to put some of the ointment on the tip. This facilitates insertion. I think it takes more than 2 weeks to be effective. I am still not healed I don't feel. I plan to use it at least another month which would total 12 weeks. Don't know what I will do at that point. I, like you, was struggling on how to apply, how much, and what applicator to use when I first started. Hope this helps. The area where the cream goes is narrow, so I would think the ointment will get to the fissure site!!
C

I got the best relief when I used more than a small amount, and shoved it up higher than just inside the rectum. I used a syringe that was intended for proctofoam.
Applying it to the fissure site is not the goal, but rather, to lower the blood pressure within the anal canal. This not only allows for somewhat better blood flow to the fissure for healing, but also seems to loosen the whole area which makes BMs a bit easier.
When I used Nefedipine, which is the same type medication as diltiazem, I often applied it about an hour or so before a bm, and then after a bm. I used it at least 3-4 times a day.

I use something called finger cots. I buy them at the grocery store - Kruegers. Anyways, they are like finger condoms. I put the cream in as high as I can go. I am on a different cream from you, Nitro, but I have had great success so far with it. I have been on it for 2 1/2 months and plan to use it for 4 months total. Prior to the nitro, I used nifedipine externally for 2 whole months and that did a whole lot of nothing for me as far as I am concerned.
If I have learned anything, it is that different creams affect people differently. What works for you may not work for someone else. If this cream does not work for you, see if you can switch to the nitro or nifedipne. But don't ever use any other creams but these 3 - as you know, the steroid creams should be used for nothing other than hemmies!!
Good luck and keep us updated on your progress!!!!

I was told to use it outside and little bit more than a pea size - more
like a half of an inch. If you use applicator, don't worry where it ends up - it will be smeared all over no matter where you put it and it does not matter at all. It does not heal the fissure itself - it just makes your whole sphincter looser and promotes blood circulation and those 2 factors help fissure heal - so, you do not even need to try to put it on a fissure to be effective.
Your fissure is most likely to be at 12 o'clock position, or in rare cases at 6 o'clock ( toward vagina). It can feel like it is on a different place but
it is just because of so many nerve endings are present in the anus- they all intertwine and fire in all directions. If it is indeed "off" the typical position, than it needs to be more closely investigated.
Best of luck and don't forget to stick with all other fissure friendly protocols : ) !

Right on what Kim said. I forgot to add that I recently have been using it prior to BM's. Good luck!!

Does anyone know...
Can I safetly use my nifedipine with my nitro? I have some let over nifedipine and I might as well use it since I paid for it. If so, should I still use the nitro twice a day plus the nifedipine?
Thanks, Jen

So glad you have some cream now Crimesofpassion !
Kim , Made a very good pooint about applying the cream before BMS, this really does help,
For me, my diltiazem states on the front of the tube to store in the fridge, the directions for use are to MASSAGE the cream one inch in and around the anus, the massage will help too!
Goodluck

My instructions were to apply it on the outside of the anus much like you would a lip balm (if you were going to apply lip balm to your anus). :)

Duh! I forgot when I made this post that my cream isn't in a tube. It's in a little bottle. So I can't really use an applicator!
Crud.
I was told to keep mine in an area where the temp is pretty constant. I wasn't told it should be in a fridge...