Week 2 on diltiazem - Pain and depressed

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Week 2 on diltiazem - Pain and depressed

Postby Laurieb » 23 Jun 2017, 08:00

I have a fissure that became chronic for more than a year now. At first, it what just an inconvenient, but with each episode (tear, healed after 5-6 weeks -re-tear) it became more and more painful. Since 5 months now I think I''ve been more in debilitating pain than just feeling normal.

Last April I've been diagnosed with a fissure by a CR doctor. Only few days after starting the prescribed Lax a Day, I healed sponteanously. I've been prescribed also diltiazem and xylocaine but didn't use it or just once because it burned so bad when I applied it. So last month, the day after a long flight, my fissure reopened. It's been 6 weeks now. I've contacted my uncle who is a CR dr and colleague of my Dr who dx me. After he consulted her about my case, he told me I should continue to use the diltiazem for 6-8 weeks using xylocain first, and told me it heals 80% of patients. Also he said the other ointments must be applied 3-4 times a day so this might not be an option. Also about LIS, at this hospital it's really their last resort because of the incontinence risk, he said. Side note, I spoke with my MIL about the problem. She has IBS with incontinence problem. She told me she doesn't wish that issue to anybody.

So now it's been 2 weeks on dilt and I don't see any real improvement. The cream irritates my canal. Even with the xylocain. Each morning after my bm, I take szith bath and go lay down until 12:30 - 1 p.m. From what I remember, in my previous episodes it wasn't that bad/long. Oh and about once a week, after a hard bm (usually they are not hard) it hurts so bad I cry right after and need to take 2 dilaudid :(

I don't know what to do. I'm thinking about the LIS but I feel it's too soon to ask? But at the same time, I'm now only half a mother to my 2 young sons, can't take care of them during the morning, my husband is very supportive but starts to be very worried, half a worker (freelance - work from home but only able the afternoons).

I'm pretty upset and tired of my situation. What hurt the most is that my children see me each day with this chronic pain. I want to speak to my CR dr but what should I tell her? I'm afraid she will tell me to keep using the cream for few more weeks...
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Re: Week 2 on diltiazem - Pain and depressed

Postby patience_and_healing » 24 Jun 2017, 22:34

Hi there, it sounds like some ingredient in the cream is causing irritation to your skin. Can you ask your doctor for nifedipine instead? It works in a similar manner and may not cause the same burning sensation. Have you considered Botox as an option? It may not heal things fully but it's worth a try since it's reversible and low risk.

Some doctors will do a fissurectomy instead of LIS which is less risk for incontinence. I don't think it's widely offered in the US though. And a good surgeon will be able to tell you honestly whether any of his patients were rendered incontinent by LIS. Don't be afraid of expressing your concerns.
8/16-12/16: Fissure due to antibiotics
5/17: Botox to sphincter, fissure healed
9/19: Trigger point injections and pudendal nerve block
11/19: Botox to pelvic floor
8/20: Botox to pelvic floor in new location.
Currently in pelvic physical therapy
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Re: Week 2 on diltiazem - Pain and depressed

Postby Laurieb » 25 Jun 2017, 08:53

Thank you for your answer, I appreciate it.
I will speak to my uncle tonight. I need to see her colleague asap. I thought also about nifedipine. I'll ask fo it if she feels the LIS is too soon to consider. My constipation also came back since 2 days. May be because of the motrin with a muscle relaxant that I've been taking. Life is unfair to me, I'm desperate.

At this hospital they don't do Botox, I would need to be reffered and wait several weeks I think to have the injection, or go to a private clinic and pay (I live in Canada) Anyway, I read that even with botox the fissure can re-opened after it wears off, which scares me.
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Re: Week 2 on diltiazem - Pain and depressed

Postby missy moo » 26 Jun 2017, 16:50

P and h how is the nifedipine made up percentage wise? I'm also 2weeks into the diltiazem an it irritates an gives me a crazy itchy feeling on the inside of the ring where I apply it. Laurieb how are you I have a 10week old boy an a 4 year old boy I've had my fissure on an off monthly for 4 years I'm using the diltiazem cream too an I'm 2 weeks in an it's irritating me too.
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Re: Week 2 on diltiazem - Pain and depressed

Postby Laurieb » 27 Jun 2017, 16:03

Hi Missy Moo,

So I gave up diltiazem about 72 hrs now. I prefer that my spasms last a little longer (in the afternoons they are not that bad anymore)

Today I went for a sigmoidscopy(?) it's a short colonoscopy to see the rectum and fissure of course. My fissure is so small and superficial! So weird and upsetting that this little irritation causes me so much pain. So I've been prescribed Nitro instead. My Cr dr told me it's supposed to be a little less efficient than diltiazem, but it dilates more the sphyncter. Will try as of tomorrow.

Also I'm on a list for a fissurectomy, blood test for my kidneys, they also want to check by MRI my lower abdomen in case of abcess and finally I will need a classic colonoscopy to make sure I don't have Chron's. So many tests. I just want to be on the operation table tomorrow...

How do you deal with your pain while being a mother? It's so difficult. On my bad days it makes me so sad and angry.

Will update about the nitro shortly.
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Re: Week 2 on diltiazem - Pain and depressed

Postby missy moo » 27 Jun 2017, 17:11

Did you have issues with nifedipine cream? Or was that not mentioned? It's not irritating like diltiazem an I've tried the nitro stuff it gives people head aches it gave me major head aches. So I'm getting nifedipine cream made today. Can you ask your cr doctor which cream is better nefidipine diltiazem or nitro? I really struggle it's been worse when both my babies were new born so very very hard
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Re: Week 2 on diltiazem - Pain and depressed

Postby Laurieb » 27 Jun 2017, 17:21

Aww hugs. We're on the same boat I guess.

From what I understand from this CR team at this hospital, they prefer diltiazem over the others. However, I read multiple times that dilt is notorious for the rash/irritation . I already have sensitive skin, I have eczema since my childhood.

About the headache, my doctor told me to start to try it in the evening so I can sleep and won't be conscient. I'll take an Advil also before, as I read in a post here.
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Re: Week 2 on diltiazem - Pain and depressed

Postby missy moo » 27 Jun 2017, 19:17

Our story's are the same
Last edited by missy moo on 27 Jun 2017, 19:30, edited 1 time in total.
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Re: Week 2 on diltiazem - Pain and depressed

Postby missy moo » 27 Jun 2017, 19:21

And I'm not sure if it's the diltiazem cream or thrush or both causing my itch an irritation I've been on antibiotics on an off for the last 10weeks since my baby was born I got mastitis 4 times in those weeks was hospitalized the last time and also struggling with the fissure.
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Re: Week 2 on diltiazem - Pain and depressed

Postby missy moo » 27 Jun 2017, 19:28

Sorry just read your full story at the top regarding the fissure an retearing. Doyou have a skin tag? Is your fissure in the front or back? Did it happen from constipation after having your baby me did when my first son was 2 weeks old an it keeps coming back like yours my son is nearly 4 these things need more then cream now I'm considering botox which in my country is the next step if that doesn't work then surgery is after that
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