Hi all,
I've been given Diltiazem cream to relax my sphincter.
I was wondering how you apply this, do you apply it to the internal sphincter? How deep should you go?
Also, do you apply it all around the sphincter, all 360 degress?
Or do you just apply it to the external sphincter?
Thanks

i didn't use this cream before, maybe u can do a search on this keyword on this forum. I have used GTN cream/nitro and i used it externally without headaches. I was told by my crs that external use is enough, and yes, 360deg.

different doctors give different advice... After years of applying various creams I find the ones that aim at internal sphincter relaxation work best when applied directly to the internal sphincter, which means going inside the anal canal. If the muscle is too tight or it is too painful, it is obviously going to have to be applied the best you can, but I find it's also a good time to practice relaxation and deep breathing to help the muscle learn to relax. Just go very very slowly and use the gentlest of pressure,breathe deeply into your abdomen and just let your finger rest there until you feel a little bit of give. It's also easier to apply right after a sitz bath as the warm water has helped the muscles to relax.

Diltiazem does not need to be applied 360 just to the area where the fissure is. Boy Drs sure do vary the directions. Mine told me, just on the outside of the anus as close to inside as possible.

After using the creams for quite some years, I use a Qtip and swab the cream slightly inside. If I apply it on the outside, it causes some skin irritation so found this way to work better for me. Just my $0.02.

My CRS said just to apply it on the exterior. It works its way through the skin. And it takes its time to work, so don't give up after a few days.
I tried to put it 'inside', with the tip of my finger using a finger cot, tried a Q tip, and a small syringe. All with painful results.

Initially I found applying the GTN internally very painful and used it externally to begin with. Now that things have relaxed a little I apply it to my forefinger if I am well relaxed or my little finger if I am in some discomfort.
The pain from my tear has eased greatly but I now have 2 or perhaps 3 piles running the length of the internal sphincter muscle. As such I have to withdraw my finger very slowly to avoid sharp pain.
Did anyone else get internal piles like that. I would guess I have them as a result of straining which is something I am trying very hard to avoid doing. :/

My Mayo CRS told me to get the ointment upwards at least 1 cm. That is what I have always tried to do and believe that is the best way. I screw on an applicator from an old hemroid tube that fits the new Diliatzem tube perfectly. An additional bit of advice is to put some of the ointment on the tip of the applicator for easier insertion.

Cheryl...
That's what my doctors have all told me too. I've found a way to do it with a finger and just go very very slowly, even if I have to sit there 10 or more minutes and keep relaxing and breathing and very slowly making my way inside.

One other suggestion--The MIND is VERY powerful. I have some written info on fissures that says to VISUALIZE healing to the area while sitting in the tub. As a corollary to that thought, I always tried to tell myself the ointment is healing and will be helpful to my condition. Try to tell yourself that as you are inserting the cream and for a bit afterwards. It can't hurt and it could help!!