I'm on week 6 of Diltiazem cream and it's been of little help so far. There have been times when i've felt improvement but as I write this today I am in a lot of pain. The CRS told me I need to give it at least 6 weeks to work so now i'm feeling quite disheartened. I was expecting to see big improvements by now. I'll keep on with the cream and keep in hoping i'll see progress. My CRS is not at all keen to give me botox so i'd rather not go down that road with him being so apprehensive about it.

You might try suggesting to your CRS that you try Nifedipine instead. It is also a calcium channel blocker, but worked better for me. Also, I used a Sitz Bath and anal dilation - but still took over a year for the spasms to decrease.