How to use nitroglycerin ointment?

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How to use nitroglycerin ointment?

Postby NeuropathicGuy » 02 Aug 2009, 18:22

Hi all,
I'm new to the forum but have been suffering with an anal fissure for the past 4 weeks. It's what I assume is your typical anal fissure, complete with the insane "like passing broken glass" pain and bleeding during every bowel movement. At times, following a bowel movement, it feels like my sphincter is still pushing uncontrollably like I'm still having a bowel movement, and there's an associated highly uncomfortable throbbing pain that lasts through the entire day (I guess this is the famous muscle spasm that comes with fissures).
Anyhow this thing has completely taken over my life now. I'm terrified of having any bowel movement, and I've just gone 48 hours without eating a single thing out of that fear. I'm 5'8" and only weigh 120 lbs. after all the weight I've lost recently, so needless to say, I can't go on like this much longer.
My doctor doesn't know much about fissures. At first he just gave me hydrocortisone suppositories, which didn't have any impact at all. Last week I managed to talk him into prescribing me some 0.2% nitroglycerin ointment (I think mixed in aloe vera gel to create the compound). He'd never heard of other treatments like botox injections or topical nifedipine so I may try to see a colorectal surgeon for information on those alternatives. My doctor did say that he can refer me for LIS, but that was the only other option he knew of. I'm quickly getting to the point where I'd happily opt for LIS, but would like to give the conservative stuff a try first.
So for now I'm trying the 0.2% nitroglycerin. My question is: how exactly am I supposed to apply it? Is it enough to apply around the outside of the anal area? Or do I actually need to put the ointment inside the anus on the fissure itself?
I don't know exactly where my fissure is located, and putting it inside the anus right now would cause great discomfort. I was on a high fiber diet with lots of salads and fruit as well as Miralax once a day, and it ended up giving me bad diarrhea, which was actually worse than constipation when it came to the fissure. So I've had a temporary setback and am waiting for the crazy spasms and throbbing pain to calm down before I can entertain any thought of putting ointment inside. But if inside is where it needs to be, then so be it. Anyway, any advice you all can offer on how to properly use the nitroglycerin would be most appreciated. My doctor seems to have no clue :(
Thanks in advance and sorry for the huge post.
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Re: How to use nitroglycerin ointment?

Postby toomuchwastedtime » 03 Aug 2009, 00:55

you will need to apply the ointment on the fissure it self. If you are not too sure on where it is. Just apply it around the cornhole. Do not eat too much fiber or you will end up hurting your self further more. Water is probably your best bet and avoid eating sharp food ( popcorn, chips etc)
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Re: How to use nitroglycerin ointment?

Postby NeuropathicGuy » 03 Aug 2009, 02:13

DOH! I was guessing maybe I'd have to put the ointment directly on the fissure. That one could be challenging as I think my fissure may be one of the kinds that's slightly further up (speculating on this as I don't feel anything right around the anus), so it's tough to reach.
Does anyone know of any ummm "tools" that can be purchased to assist in the ointment application process? I've heard of people using Q-tips but that seems like it would be hard to control, and could possibly leave some cotton behind?
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Re: How to use nitroglycerin ointment?

Postby Deleted User 5 » 03 Aug 2009, 05:45

No, actually, the ointment only needs to be put just inside the anus, it is not for direct healing of the fissure but indirectly, by setting up conditions for normal blood flow withing the anal canal, so it is not to be applied directly to the fissure (to my knowledge). TMWT's advice about the hard or sharp-edged foods is a very good one, peanuts, for example, would be a food to avoid (unless boiled)....
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Re: How to use nitroglycerin ointment?

Postby cherylk » 03 Aug 2009, 07:17

They gave me a "tool" to use with my ointment that was long and rigid. I ended up using a rounded "tool" that I was given with my Anusol ointment for hemmroids, and that "tool" worked extremely well once I was able to relax and not fear the insertion (because of pain). I was told by my Mayo doc to get the ointment up into the canal at least 1 cm.
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Re: How to use nitroglycerin ointment?

Postby NeuropathicGuy » 03 Aug 2009, 12:01

Thanks guys! I have an applicator tip kind of thing from a tube of Anusol hemmorhoid cream and will try that. My anal area is super sore all the time, so getting it in there probably won't be comfortable, but the tool is pretty small so I think I can manage. Hopefully this at least gives some kind of improvement, the pain is getting to be unbearable. Thanks again!
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Re: How to use nitroglycerin ointment?

Postby Deleted User 5 » 03 Aug 2009, 12:47

Does it just say, "apply to affected area" on the tube?
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Re: How to use nitroglycerin ointment?

Postby NeuropathicGuy » 03 Aug 2009, 12:50

Kim wrote:Does it just say, "apply to affected area" on the tube?

Yep it just says "apply to affected area 3 times daily". The actual ointment is something called "0.2% nitroglycerin in aquaphor ointment".
I put it on a plastic applicator this morning but am unsure of exactly how much got inside the anus. In the past I could tell by the side effects (a throbbing headache that comes on quickly and subsides quickly) but I don't think I get headaches from nitro anymore (they stopped after the first day or two of using it), so it's hard to say if it got where it needed to be.
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Re: How to use nitroglycerin ointment?

Postby NeuropathicGuy » 03 Aug 2009, 12:51

Should add that I'm in the US, so the ointment bottle basically says whatever my doctor wrote in the prescription, since the 0.2% is custom compounded by the pharmacy. My doctor doesn't seem too knowledgeable about fissures (he claims that they just go away with use of hydrocortisone suppositories and fiber) so I don't think I'd trust his instructions too much to be frank.
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Re: How to use nitroglycerin ointment?

Postby gahgah604 » 05 Aug 2009, 06:52

Run to the closest CRS! I would not even bother going back to your doctor!
as for the cream, the further you get the cream in... the better!
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