How long can you stay on the creams (Diltiazem)?

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How long can you stay on the creams (Diltiazem)?

Postby Luka » 07 Apr 2014, 17:27

How long can you continue to take the muscle-relaxing/blood flow-increasing creams (Diltiazem, Nefidipine, Nitro) for a chronic fissure? Is it dangerous to keep taking them? I’ve been on Diltiazem since last January… more than a year. I know, I shouldn't be on it that long. I’m too afraid to stop taking it. The last time I tried, I had pain again. When I take it twice a day, it relaxes the muscle enough so that I feel fine. My flare-ups have gradually decreased since last January and my pain level is 1 or 2 most days. I seem to mainly get flare-ups (more pain) during periods of high stress, as I get really tight down there. : (

I have an appointment with my CRS next week to discuss this. I’m afraid he won’t prescribe me any more cream and suggest surgery. I’ve only been on Diltiazem, nothing else. I still don’t have health insurance and I absolutely DREAD surgery of any kind, especially butt surgery! I seem to be fine as long as I use the cream. I'm also dreading getting any kind of scope exam, so I'm hoping he just looks at the outside area (my fissure is more internal, though). I do not want to risk a re-tear.

Thanks for your help. It's been a while since I've posted here and I'd appreciate any advice you guys have.
January 2013 - Diagnosed with fissure. Eventually turned chronic.
History of IBS and anxiety disorder, along with fear of using bathrooms other than my own caused it.
Tried Diltiazem, but eventually developed a rash.
LIS surgery scheduled August 26th.
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Re: How long can you stay on the creams (Diltiazem)?

Postby Jbl22424 » 07 Apr 2014, 18:03

Hi Luka,
I'm on nitro and I will feel comfortable being on it long term if needed. This excerpt below was pulled from the Anal Fissure Self Help Page, it was an email written by Dr. Gorfine, a CRS in New York. Based on the help he had provided the folks who created that web page many years ago, I would go see him if I lived in that area. At any rate, he says nitro (GTN) can be used long term.

"There does not appear to be any upper limit to the amount of time one can use NTG for fissures. Your chances of healing on NTG therapy are time related. There are now 4 papers in the medical literature which show 65-88% healing rates at 6-12 weeks. Many of my patients who do not heal within this time frame elect to continue NTG therapy. Many of those will heal given enough time. Remember that cardiac patients use NTG in much higher doses for many years without ill effect. If you are not in pain, there is no urgency to perform sphincterotomy."
Developed fissure from constipation due to breastfeeding 7 weeks after delivery (Jan 2014)
Nifedepine
Colace
Magnesium
Miralax - godsend
Nitro - some improvement
LIS (May 2014) - cured for 3 months then setback
Diltiazem
Feeling better for now
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Re: How long can you stay on the creams (Diltiazem)?

Postby Luka » 07 Apr 2014, 18:31

Thank you for the reply, Jb. I know I've read that some people have used the creams long term on this forum. There used to be an old post about it, but I believe it was deleted when this forum moved to a new website. From what I remember, people said it was okay to use the creams long term since it's not like hydro-cortisone that thins the skin and only increases blood flow to the area. I know some people have had really nasty allergic reactions to Diltiazem, but I haven't had a problem with it (knocks on wood) and I am afraid to try Nitro since I hear the headaches are really awful with it.
January 2013 - Diagnosed with fissure. Eventually turned chronic.
History of IBS and anxiety disorder, along with fear of using bathrooms other than my own caused it.
Tried Diltiazem, but eventually developed a rash.
LIS surgery scheduled August 26th.
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Re: How long can you stay on the creams (Diltiazem)?

Postby Scientist2516 » 07 Apr 2014, 21:44

Hi Luka,
I don't see any reason not to use diltiazem long term if you have no allergic reaction to it, and if it's working for you. Honestly, if you are fine while on dilt, that's fantastic! Maybe you are actually healing. I also get a little pain when I'm stressed and holding a lot of tension in my bum. Most of the time I'm fine though, and consider myself healed (I don't use any medication any more).

If you want to try nitro, you may not get the headaches. I used it, and only experienced a mild throbbing that soon ended (less than 5 mins). If the nitro isn't too expensive where you are, it could be worth a try. You could keep nitro in mind in case you do ever develop sensitivity to diltiazem.

Good luck with the consultation. There's a chance the fissure is healed, but still paining you. Like a broken bone goes on aching after it has healed. I really hope you are healing!
Nifedipine/lidocaine, no help
Diltiazem, effective, but caused major rash
Nitroglycerine, effective.
Topical estrogen for final healing.
Gentle heat to bottom - pain relief, muscle relaxant
Kondremul mineral oil
Time - lots of time.
Status - Healed!
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Re: How long can you stay on the creams (Diltiazem)?

Postby owmybum » 08 Apr 2014, 04:24

Hi Luka,
I'm so glad to hear things are so much better for you.
I personally don't see a problem using the diltiazem... It's not skin thinning. I would think your CRS is the one to ask though. I hope he declares you healed!!!

OMB x
fissure after hem banding and tag removal feb 11
Pelvic floor therapy
Diltiazem
Botox June 13
Nitro
Internal flap July 14
EUA and polyps removed Nov 14
Diagnosed with neuropathy Jan 15
Diagnosed with HS EDS type 3 (causes poor wound healing )
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Re: How long can you stay on the creams (Diltiazem)?

Postby Luka » 08 Apr 2014, 12:05

Thanks for the replies, Scientist and owmybum. It's reassuring to know it's safe to use as long as I need it. I just really hope my CRS renews it and doesn't give me a difficult time. I just can't see myself getting any kind of surgery when I don't have much pain anymore and feel fine when using the cream.
January 2013 - Diagnosed with fissure. Eventually turned chronic.
History of IBS and anxiety disorder, along with fear of using bathrooms other than my own caused it.
Tried Diltiazem, but eventually developed a rash.
LIS surgery scheduled August 26th.
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Re: How long can you stay on the creams (Diltiazem)?

Postby lefthanded » 13 Apr 2014, 06:32

I have been using diltiazem for about 6 years or so. I do not have perfect spams control, and my fissures are chronic, but without it my life would be miserable, impossible. I use it when I self-dilate, which I must do regularly.
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Re: How long can you stay on the creams (Diltiazem)?

Postby Luka » 15 Apr 2014, 15:11

Thanks for the replies, guys. I saw my CRS yesterday and he said he still cannot see the fissure. -_- I just get too nervous and tight for a good inspection. I know I have one, though, since I can see part of it myself in the mirror when I'm not so tight. But he did prescribe me more Diltiazem and said it's safe to take long term as long as it seems to help. He said it is still possible for the fissure to heal completely, although it will be difficult. I asked him about botox as a next step and he said it has such a low chance of success (and is also VERY expensive) that he rarely performs it on his patients. He said the next step would be LIS and fissurectomy. *sigh* So that would be my next option when I am ready for it and I know no surgery should be take lightly. He also said his patients have very little pain after the surgery and are back to normal very quickly, free from any kind of fissure pain. From what I've read on this forum, that doesn't seem to be the case with many people. Any surgery, let alone butt surgery, scares the heck out of me, to put it mildly, especially because I have an anxiety disorder and depression. I will just see how I do with the cream for as long as I can and will take that next step if and when I need to. I hope and pray everyone here finds permanent relief from this horrible affliction.
January 2013 - Diagnosed with fissure. Eventually turned chronic.
History of IBS and anxiety disorder, along with fear of using bathrooms other than my own caused it.
Tried Diltiazem, but eventually developed a rash.
LIS surgery scheduled August 26th.
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Re: How long can you stay on the creams (Diltiazem)?

Postby Alyssa » 11 May 2014, 17:21

Luka wrote:Thanks for the replies, guys. I saw my CRS yesterday and he said he still cannot see the fissure. -_- I just get too nervous and tight for a good inspection. I know I have one, though, since I can see part of it myself in the mirror when I'm not so tight. But he did prescribe me more Diltiazem and said it's safe to take long term as long as it seems to help. He said it is still possible for the fissure to heal completely, although it will be difficult. I asked him about botox as a next step and he said it has such a low chance of success (and is also VERY expensive) that he rarely performs it on his patients. He said the next step would be LIS and fissurectomy. *sigh* So that would be my next option when I am ready for it and I know no surgery should be take lightly. He also said his patients have very little pain after the surgery and are back to normal very quickly, free from any kind of fissure pain. From what I've read on this forum, that doesn't seem to be the case with many people. Any surgery, let alone butt surgery, scares the heck out of me, to put it mildly, especially because I have an anxiety disorder and depression. I will just see how I do with the cream for as long as I can and will take that next step if and when I need to. I hope and pray everyone here finds permanent relief from this horrible affliction.



Have a question regarding your post... So your doctor cannot see the fissure (did he diagnose it in the past) and is offering the Lis surgery as an option? Have you decided what your next step will be? Where are you located?
2/14 Fissure developed
3/14 Diagnosed w/ fissure given Nifedipine
4/14 Referred to Pelvic Floor Physical Therapy=Pelvic Floor Dysfunction
5/14 Fissure declared "healed"/chronic anal pain persists
9/5/14 Botox to pelvic floor
9/22 biofeedback
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Re: How long can you stay on the creams (Diltiazem)?

Postby Apes » 11 May 2014, 18:07

I asked him about botox as a next step and he said it has such a low chance of success (and is also VERY expensive) that he rarely performs it on his patients. He said the next step would be LIS and fissurectomy. *sigh

I have done extensive research on Botox and the success rate can vary greatly. What I have determined for me, if Botox is injected in the right locations it can be very successful. Also, higher amounts have proven to be more effective. There are many on this forum who have had success. Lifestyle changes and diet are important after. You can't get the injection and go have a steak and a bottle of wine. I would get a second opinion. Most crs use Botox as a step before surgery. I was faced with which way to go and decided on Botox. I just wasn't ready to jump to surgery. Good luck.
Fissure 2/13/14 from Colonoscopy
Nitro no help
Nifedipine no help
Botox 5/5/2014 work in progress
HEALED 10/2014
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