I always assumed that a fissure is typically very close to the opening of the anus. Well I saw a colorectal surgeon for the first time and he told me the reason the nitroglycerin was not working is that I wasn't applying the cream far in enough, due to my fissure being quite high up.

This time around I insert my entire finger in (~ 3.5 inches?) when I apply the cream, although I still haven't really seen any improvement. The colorectal surgeon assured me the fissure was not large, and it would heal in 2 weeks (given that this pain has been with me for exactly a year, I'm not too optimistic about that). I asked him what to do if it doesn't heal, and he said "it will" and sent me out of his office.

Well I don't know what to do. Is it possible the cream is still not going in far enough? Could dilation help if the cut is this far in? I don't know where to go from here. I am still applying the cream although I don't expect any results.

Is there any way u could call your colorectal surgeon and ask if he or she could be more specific about how far up the fissure is so that you would at least have some idea?

I was told by someone else on this forum that it wasn't necessary to apply the gtn ointment inside the anus, but that putting it around the outside was good enough. I tried a few times to insert my finger inside to apply the ointment but found that it just caused the fissure to become infected and found that leaving it alone worked better. I am 15 months into suffering on and off with a fissure and am having exploratory surgery in February, gtn and diltiazem ointment both weren't successful for me. I would love to know how far "up" my fissure goes. Maybe I'll find out... Good luck x

The ointment is to relax and dilate the anal sphincter muscle to allow blood to reach the whole anus, so it should be applied just inside the anal opening, no where else. No point trying to get it further in beyond the sphincter!

The length of the internal sphincter is only 2-2.5 cm so higher than that is not going to do any good. Application to the opening of the anus should be enough as it gets absorbed and transmitted to the rest of the muscle that way. Probably best to not be putting anything inside with an active fissure...

Nitroglycerin is very well absorbed and is transported quickly around the body (think about it - putting on your anus can give you a headache). So I wouldn't worry about trying to put it up inside. It will get to where it needs to be.