Hey guys and gals,

I have a serious question. I have suffered from a small fissure for up to 4 months (possibly a second one forming but i have to get that verified by my crs in 2 weeks.)

Ive started taking miralax 15 g once in the morning. SHOULD I STOP TAKING COLACE TWICE A DAY?
SHOULD I TAKE MIRALAX MORE THAN ONCE PER DAY?

I noticed that after defecation my spasms arent really that bad. I found when my spasms get out of control and the worst, is after i apply 0.2% nifedipene mixed with 1.5% xylocaine. I did it just the way the GI instructed with my finger, gently, slowly, fraction of an inch at a time while gently putting more and more ointment in there. I find after that i get the WORST feeling of spasm however i wanted to know:

is this what i am supposed to be feeling? am i just feeling the spasm more because its actually released to a point where i CAN feel it? vs being totally contracted shut all of the time and not really being able to feel those same sensations.

I want to know if i am potentially injuring myself more by applying this cream or if in fact it is helping me and i just dont understand what i am feeling.

an alternative i was told was "use anusol cream morning and night and after defecation and an anusol suppositoy every night"

although it is less painful to apply, i dont want to feel better for a few days only to feel worse after. Any of your feelings on how the sensations are after using nifedipene would be greatly appreciated.

Answering on subject question, I can only comment that didn't feel any kind of effect from nifedipine, and from GTN also...

The nifedipine is supposed to relax the anal sphincter - it's a calcium channel blocker that inhibits muscle contraction. As I understand it, the spasms are painful muscle contractions, and they are to be avoided. If applying nif internally causes spasms, I would seriously stop doing it. The spasms cause pain, and the pain causes spasms, so you've got yourself a nasty vicious cycle there. The nifedipine should be absorbed by the anal muscle, and act, even if it's applied externally.

That said, nifedipine did nothing for me, and I used it for two months with zero effect. Diltiazem was more effective for me. It is also a calcium channel blocker but for some reason it worked better than nif, on me. The most effective drug was nitroglycerine, and that is very easily absorbed by the skin. So if you want to apply something externally to the anus, I would recommend nitro. It gives some people headaches though. Nitroglycerine is not a calcium channel blocker - it works by some other mechanism.

As you can tell from Igrik's response, drugs tend to work for some people and not others. We all have different biochemistry!