Hi all!
I'm rounding out four months of fissuring. I've been on diltiazem for over two months now, applying twice per day to the best of my ability. It seemed to help initially but progress has plateaued and, though I'm better off than I was, I'm certainly far from feeling normal/well/happy. I am just wondering - would it be worth it to try switching to a nitro ointment? I know people sometimes switch to that if the diltiazem causes a rash, but that nitro is not hugely popular due to the headaches it causes.

So, my question is - what is the difference in the functionality of the two? If one doesn't work (or work as well as hoped), is there any chance that the other will be more effective? Just wanting to explore all of my options before taking the surgery plunge.

Thanks in advance for your help!

Hi zippity,
I would say try it! The nitro helped me more than the other two creams I tried, and the headaches for me were really minimal - just a few minutes of pressure and slight throbbing. Start with very tiny amounts and work up to a pea-sized blob.

Dilt and nitro do work a bit differently. Dilt is a calcium channel blocker, and blocks contraction of the smooth muscle of the internal anal sphincter. Nifedipine works in the same way. Nitro works by being a nitric oxide donor, so the pharmacology of nitro is different, but the end result is the same - they are all muscle relaxants for smooth muscle; they relax blood vessels and relax the anus.

If you've built up resistance to dilt, switching to either nifedipine or nitro would be a way around that.

Scientist has given you a fab reply and I would just add that not everyone gets headaches with the rectogesic. I have used it for months without any headache at all. Definitely worth a go :)

Not gotten headache from it either. Apply only a small amount each time.

Awesome - thanks guys/gals. There was a problem with getting the prescription filled but once the pharmacy and my doc work it out, I'll definitely give it a try!