New here but in agony for approx 3 months. From some reading I see some use the nitro cream inside the anal area? Mine say outside? I'll post more later but I have two internal fissures and adrenal insufficiency after a surgery in May. Thanks!

Hey Janet,
Welcome, you have come to the right place... This forum is excellent for support. My CRS said it is best to apply right inside to get full effect from the Nitro. I always find it best to use a covered finger and insert into the anal canal.i have found that it is best to work up to the full dose of 2.5 cm though, as a side effect of the Nitro is headaches, although I would rather have the headache than the Fissure pain!! If it is too painful I have in the past used a cotton bud to apply it just inside. Use it for the full time stated. Are you taking a stool softener and lubricating prior to a BM? This will really help too. Good luck, keep us posted.

My brother, the surgeon who got me started down the right path for healing, told me the nitro will work, at least initially, from the outside. I believe inside is better unless too painful to apply. The headaches were not a problem for me if I applied the nitro immediately before sleep. I tried it in the morning but it messes with my thinking. It took 3-months of nitro, Miralax, fiber, and lots of water before I could quit fearing the next BM.

Thank you will try that. More tomorrow or Monday, I'm a recovering Cushings patient and this has been worse than my adrenal surgery.

ask your doc for "FREE RUBBER GLOVES" and use Qtips if inserting inside, ..."a little dab will do you!"f

Janet,
Although there are differing opinions on this, I also believe that internal application is better and especially if you are able to get close to the internal sphincter muscle, as the cream is more likely to have a stronger and more direct effect. If you are struggling with applying it, you could always purchase a pack of the Anusol hem cream as they tend to come with small syringes for easier application? A few people have done this.
Lying on your side with your knees tucked up close to your chest will open up the anus more and make insertion easier for you. I think once you've found what works for you, it doesn't take too long to get into a routine - key is just being as relaxed and gentle as possible until you feel comfortable with the process.....Good luck :)

I put a blob on the end of my finger, and sort of lightly press it against my anus, so most goes in without the need to insert my finger.... I just can't bring myself to do that!

OMB x

I wonder the same thing about these ointments. I am taking .3% Nifedipine & Lidocaine for the past week now. So far, not a huge improvement. Still sore, raw down there, but luckily I suppose, not in constant pain, just when I pass BM, almost every time. Like a sharp sting. My instructions say for external use only. Guess the anal muscles can absorb the ointments, I apply mine right around the outside area without actually going inside. I don't want to do that without talking to my doctor first.

Wondering if it's just going to take more time for the ointments to start helping me, or if maybe putting a bit inside would speed it up..I haven't tried nitro yet, might ask about it next week at my doctor's appointment. I have a skin tag there that is irritated too, so it aggravates it. But CRS didn't think it was a big deal. So I dunno.

This study showed fewer headaches and better healing outcomes when nitro. was applied internally rather than just on the outside.

http://www.ncbi.nlm.nih.gov/m/pubmed/22810476/

(Obviously though, you don't want it to be some kind of torture you're putting yourself through every time you apply it)

I've been finding with Nitro it causes irritation and a different feeling from the fissure. I've also noticed a horrid smell sometimes too, like smelly socks.

But back on topic, due to pain or stress I never quite read or absorbed the instructions properly initially but it says put 1cm into the anus although it also states up to first joint which due to my long fingers is more like an inch than a cm. Initially I think I was actually putting my finger up there too far, maybe 2 inches - ha ha, ooops. It's hard to measure when you cant see and off course when you first push against the anus it's spongy anyway so not sure how far in the finger has gone.
The technique I now use is to squeeze out the Nitro from tip of finger to first joint that's about an inch rather than using the measurement on side of box. Either way, about 2.5cm. I then use another finger to push the Nitro to tip of finger to form a blob. I then push against the finger against anus a little and rotate the hand slightly in a circle which results in tip of finger well coated. I then push in slightly then back out, then in to about an inch and by this time both finger and entrance to anus are well lubricated. This technique for me results in no pain and most seems to be inserted.
Personally I don't put any plastic on the finger but ensure hands thoroughly cleaned both before and after. It's a pity it doesnt come with an inserter as using a finger with or without plastic has the risk of the nail not helping things