Discussions that mention nifedipine

Bowel Disorders board


Walt, at 8 weeks, just at the point where you are, I saw my surgeon too. I, too, had a 'pimple' on my swollen mound where I also had my open cut. That pimple was an abscess. If you read a month back I posted about that. It took applying the gotu kola for a full month afterwards for everything to go away, and I mean a full month after week 8 when the abscesses were there. So, actually, you still are in midstream of recovery, as unbelievable as that may sound.

Your doctor wasn't pulling your chain when she said everything looked normal. Yes, everything for you is normal for this god-forsaken recovery process. What she really is saying everything is normal for the setbacks and abscesses you still have to endure.

I saw my surgeon today and my worst fears were confirmed: that setback I had a week and a half ago, where it felt that this extra large bm was tearing me up, did in fact tear me up, and left me with a fissure. He said I would need more surgery to get rid of the built up scar tissue where the fissure was, or it would repeatedly reoccur. I told him I wasn't going to have surgery, especially now that I know what that kind of pain can mean, plus I have read that surgery doesn't always help heal fissures.

He then prescribed nitroglycerin ointment to help heal the fissure. But I also have read many people not having success with the nitroglycerin ointment, and that they got bad headaches from it. Since I am allergic to aspirin and I don't tolerate tylenol well without stomach upset, I refused to take the nitroglycerin.

I did some research online and found that there is actually a newer treatment with a significantly higher success rate, using an ointment called nifedipine ointment, and supposedly, you don't get headaches.

I asked my doc to call this into my pharmacist and he did. This had to be compounded as it is not a ready made ointment. I will let you know how it goes for me. I will also now drop gotu kola on the fissure, now that I learned where it is and can see it when I do my self-exam contortions.

2 weeks ago for a period of time, I did feel almost totally healed. Then I got a too large and hard bowel movement that tore me and gave me a fissure. Why? Because my butt hole was a bit narrowed from the surgery scars. So this has been a complication of the hemorrhoid surgery. Now I find myself still having to doctor my butt now for another couple of months.

As far as your current state, Walt, you are experiencing the norm, no kidding. I know you are frustrated, but it takes time. You haven't been using the gotu kola for very long, and you have also been using it while your body is still reacting to the vicryl. You have to hang in there, and keep at it; you really have about 6 more weeks to go to get to the shores of normal comfortable butt. And I mean shores, as you still will have a bit to be on firm land after that, still prone to ocassional setbacks just like the darned one I am getting through.

By the way, my surgeon said my surgery was healed inside me completely, yeah. But I only got to experience about 5 days of comfortable before I got whammed with a fissure.
Tammy, I am so sorry about your fissure. Unfortunately, through personal experience, I know way too much about anal fissures. A chronic anal fissure is what brought me to a colorectal surgeon and ultimately, to surgery.
Statistically, most anal fissures eventually resolve on their own. I was not in that group. Mine was chronic and developed a sentinel skin tag, that several doctors "diagnosed" as an external hemorrhoid... Wrong! Oh my gosh, the pain from that skin tag almost pushed me over the edge! My fissure was very deep and located between two internal hemorrhoids, hence the need for the fissurectomy, hemorrhoidectomy AND sphincterotomy. I was too far gone for Nifedipine and Nitro was never an option, due to migraines.
I have read about some very good results using the Nifedipine with Lidocaine. I really hope it works for you!
Walt, my fissure is about half an index finger into my sphincter opening on the bottom. I hadn't known it was there, because it actually felt like it was further in. But when my surgeon told me how far in it was, when I got home I got on the floor and used my trusty mirror and headband light to find it. I had to pull apart my sphincter to see it, but it was evident as it was bleeding a little at my pulling it apart and looked like a deep thin cut right in the center bottom fold.

At 8 weeks, I had a cut on the outside that responded to the gotu kola. It wasn't a fissure, but a small hole left over from a suture that was stubborn to close. I also had a lot of real pus coming out of my butt. I used the gotu kola inside of my butt for 4 weeks after that and it DID clear up the internal pus.

This fissure happened 2 weeks ago from a too large and hard bm. It does not produce any pus; it does bleed a bit though. That's why I don't think your pus is due to a fissure, but to the regular vicryl side effects like I had---although you may have a fissure on top of that internal vicryl pus problem.

My surgeon gave me a prescription for nitroglycerin to use on the fissure, but I had no intentions of using as I had read lots of people get massive headaches from them, and I do not find life acceptable with headaches. Not only that I read lots of people got no results from the nitro. I have endured too long of pain in my butt to prolong finding the right treatment and fiddle around with poor ones.

I stumbled across a couple of studies of the nifedipine yesterday. Both told of really great results and no headaches. First I called around my local pharmacies to see if any carried it, then I learned that it had to be compounded. I found a pharmacy that would do it for $40, not bad. The amount had to be 0.2% nifedipine ointment---you don't take it orally, but put it on as an ointment directly.

I wasn't sure if my surgeon would be insulted at my refusing his prescription and coming up with another one, but frankly I didn't care, as it was more important for me to heal my butt, not step lightly or worry about offending him.

Well, thankfully it helped to be armed with the phone of a pharmacy his nurse could call, and then compounding amount of 0.2% so they wouldn't have to do any work themselves to figure out how to do it, as I had figured that out for them. At first my nurse tried to counter that I might not get headaches with the nitroglycerin, etc, but I just told her I didn't want to take it, and that this other one was said to not give headaches. I also told her I had a found a pharmacy that would do it. That was all it took, and she called it in.

I have since put on my first dose, and it did make me feel a bit better a little later. However, I also am using gotu kola right on it, dropping liquid on it, and that has also helped. Now that I know where this little fissure sucker is, I am actively bombarding it with all kinds of treatments to get it to heal.

If my surgeon had been stubborn, my next step was to email him or come in with a print out of the study that showed that the nifedipine was 100% better in healing fissures than the nitro, but I never had to take it that far. If your surgeon won't do it, try asking your regular doctor. But first find a pharmacy near you that will compound it, if you want to try that.

You have to be careful though, and just dab on a BB pellet amount or smaller, as this can cause your blood pressure to drop if you take too much. The studies I read had no side effects, but that is a potential of the drug.

Even with this fissure, I am functional, and if I had a job, I could go to it, but I have been aggresively treating my fissure with gotu kola, and now I've jumped on this nifendipine thing. The worse part is the sudden times I have to go have a bm, and all of the peeing I still have to do because I have to drink so much to keep my stools soft.
Walt, sorry your butt is on fire. Have you been putting a glob of vaseline on your butt hole right before having a bm? This helps a lot to cut down on burning.

Here is how I saved my butt from burning in-between stools. Runninggal told me about this life-saving ointment called calmoseptine ointment. It is made specifically for anal discharge and recovery. You owe it to yourself to get a tube and then inbetween stools just smear a line on either side of your butt hole, and it will greatly help relieve that burning.

Maybe you do have a fissure on top as you suspect. Make an appointment with another surgeon to look just at that, and see if it is a fissure. It wouldn't hurt to try some of that nifedipine ointment. In just a day it is giving me relief.

I advise you to show up at work, as new bosses can be trouble. Take along vaseline, calmoseptine, cotton balls, etcetera.

Listen, why don't you try some elocon cream on that sore spot for the next 4 days, one application only right before bed? It might help you. I had a sore itching spot right outside my rectum last night that looked like the start of an abscess, and I dabbed some elocon on right before bed and come the morning it was healed.

Getting over this is all about hit and miss and keep on trying. I know it seems impossible to fathom, but having your troubles at 8 weeks is normal, I had those troubles too. But I did then treat myself inside with that gotu kola for a month afterwards, and that did help.

I have to tell you that healing from these problems takes a damn long time, and you have to develop the longview to this healing process. I know you are pressured by your work place to make a normal recovery, and that is too bad that you have to deal with that at a time like this, but you, yourself, have to embrace that the problems in your butt take time to heal.

Take for instance this damn fissure I have---yeah, I got some things good to treat it, but it will take from 6 weeks to 3 months to work, okay? So if I start to get stressed out 2 weeks from now that I am not healed, it doesn't mean the things I am taking are not working. I see you stressing out that nothing is working fast enough, and then it seems that you feel that those treatment modalities are worthless, but I am trying to tell you don't lose hope, and keep on treating yourself with those things, and believe that you will be better. You will.

Get some calmoseptine. It will help you. Try some elocon cream tonight. And have a good sleep.
Tammy,

Yes I've been using a glob of vaseline right before my BM. I've been staying away from any type of ointments because of my cut whatever.

I called my surgeon and informed her I wanted to see another surgeon. Her nurse is going to call me in the morning with the details. Although, my surgeon said I was fine even after I told her how much burning and pain I was in. I told her about the nifedipine but she indicated I did not need it.

Right now it seems like my whole insides want to come out my bum hole.

[This message has been edited by wjpjr (edited 10-16-2003).]
runninggal, I don't know if you are referring to the powdered form of tinactin, but I just used the cream today, and it actually improved this burn rash I had on my inner butt crack, which I think was initiated by the nifedipine cream I've been putting on. I looked at the label and the tinactin cream doesn't have any ingredients that would cause burning. I also found the cream recommended for treating fissures in a health remedy book. That person that experienced swelling like a pumpkin, what version of tinactin did he use? I'm not pushing this cream for anyone to use, but it's another alternative to try besides surgery. My fissure is at 6 oclock like Walt defined, so I guess it's a classic position.

At this point my fissure does seem to be responding to the nifedipine and tinactin treatment. But I really need to have weeks without any hard stools to heal. I know that fissures take weeks to heal at best. I had a fissure when I was 18 years of age. I was young then, but it did heal fully after a few months. I hope my body hasn't gotten too old to heal again because I know my body is too old to go through once more any kind of surgery as painful as my two hemorrhoidectomies. :)
Walt, from what I understand, you can post an url that leads to a strictly information site, with zero commercial ties, like the government sites, and I believe another bullentin board without any ads would be okay. Out of curiousity I would like to read it, because today I want to share my AMAZING results using the tinactin cream. I am very pleased.

I read about using antifungal creams on fissures in this book, The Home Remedies Handbook, by the editors of Consumer Guide. I then read several people who used tinactin on their rectal fissures with success, but one fellow tried another brand and actually burned himself, so he recommended just using the cream and the brand name tinactin, because that worked for him. Now some other person tried the powder and got bad irritation. Now that makes sense to me because I tried using cornstarch powder on my rash after surgery, and only felt pain, and had to remove the powder.

Now this whole antifungal thing makes more sense to me, because I saw my general doctor this past September 22nd, and he prescribed for my butt burn an antifungal cream called lotrimin (I think that was the name, but I've misplaced the prescription) which is usually used for yeast infections in women. The reason he did this was he believes my rash burn is due to a fungal infection from the discharge from my rectum due to the surgery. He believes it to be a fungus because every thing I tried, desitin, aveeno, wouldn't do anything to take away this rash burn.

What this rash/burn looks like is right where my butt cheeks touch together, about 5 inches long, I had a 5mm wide curved burn welt on either cheek, that burn and hurt like the dickens. Well with just 2 applications of tinactin, I have had a 75% improvement, and am extremely pleased. This makes sense if my doctor was right that it was a fungus. I also have stopped bleeding from my fissure and feel significant improvement there as well, as I actually put a dab on my fissure as well.

I have had no adverse reactions whatsoever, only tremendous relief. I don't know who that person is saying they got a pumpkin size swelling, but if they had that would have been a medical emergency, and I would have thought that person would have been in serious lifethreatening danger. The cream has benign filler ingredients. I suppose it is possible for someone to be sensitive to the antifungal agent, tolfanate (sp?) but for me it has been a miraculous treatment. I am going to continue to treat my fungal burn with the tinactin until it is completely gone.

The reason I didn't use the prescription fungal med my doctor prescribed is that I have had reactions to prescription antifungal creams that I didn't want to experience. I have experienced bad stomach cramps and diarrhea from the application of these creams on the outside of my vaginal area, and so I was very reticent to put on a cream to treat my rectual burn with something that might give me cramps and diarhhea and possibly cause me a setback in my butt.

I also have to report that I am very happy to say that I have had zero adverse reactions or symptoms from that prescription cream nifedipine---I was afraid of experiencing low blood pressure or headaches, but I am glad to say I have felt absolutely nothing at all bad. The studies I read reported that people had not had side effects, but I wasn't so confident about reports other people had had, and had to try it and see if this was also true for me. And gladly it is.

In the last 48 hours my fissure has greatly improved, and this really makes me glad, as I expected the healing to drag on for 2 months. I didn't expect to feel this much better so soon.

I must add, though, that no one in the first 6-7 weeks should use the tinactin or the nifedipine, because no cream should be applied on new unhealed surgical wounds. These treatment plans are only for those in the latter part of 2 months plus, who are having persistent fungal burns or fissures.

If you have any of those conditions in the early part of recovery, you just have to tough it out with analpram, until your wounds close.
Tammy,

The url is [url="http://www.boardsailor.com/jack/af/patient_32.htm."]http://www.boardsailor.com/jack/af/patient_32.htm.[/url] Look at the post titles "Subject: Tinactin Advice - A Note of Caution". I'm glad you are getting good results. I am waiting till my appointment with the new colorectal surgeon on Wednesday. I will bring up the use of nifedipine and ask about using tinactin for fissure treatment. I do know my previous colorectal and current surgeons cautioned the long term use of analpram because the strong (2.5%) hydrocortisone can damage the mucosa lining.

[This message has been edited by wjpjr (edited 10-19-2003).]

[This message has been edited by wjpjr (edited 10-19-2003).]
lbp35, first off keep taking colace for a good 2 months after your symptoms are gone. Next you should be constantly keeping your butt hole moist and protected with something like a&d ointment as I use from CVS, called Protective Ointmentm or Eckerds--not fogoura as that is too thin of an ointment. Dry skin can promote cracking or tearing of your butt hole, which is why it is imperative you put a pea-size glob of ointment just inside your butt hole opening. This will help your healing.

I had a fissure which I healed using 2 weeks nifedipine ointment, followed by 5 days of elocon cream. The elocon cream made a huge difference; it comes as an ointment or cream, and is made for skin inflammations and problems, and it helped to bring down the swelling in my butt hole from the fissure and heal it as well. From then on, I had to, and still do, put a dab of a&d ointment in my butt hole after every bm, and every hour or two to keep it constantly well-greased and supple. In other words, I constantly worked at making sure my butt hole was protected and aggresively treated any problems.

I now have a little tiny cut in another area that I am treating, and it has significantly improved in the last 2 days since it appeared due to too many bowel movements. I used elocon once each night, and A&D ointment several times per day.
lbp35, I completely agree with Walt on exercising great care about popping meds for anxiety or depression. These meds are meant for people with chemical imbalances, but, in recent years, have been abused and twisted, by many doctors and therapists, to treat feelings of depression and anxiety due to genuine causes. It is almost as if having normal feelings these days are taboo, and we are becoming a society of anesthesized zombies. Any drug your doctor gave you because he wants to 'turn off' your feelings of anxiety with a pop of a pill, you should visit the drug manufacturer online and read all of the possible side effects. You need to be fully informed about all of the adverse effects of that med before you dare swallow even one.

I have known people, who were normal before they took anxiety drugs, to commit suicide as a side effect of these drugs, to lose their sanity and seems like crazy mental patients. I have personally known people who have taken these drugs for short term anxiety and then found they were addicted and had to go through a long withdrawal process, or risk terrible side effects. Not to mention, what if some of these drugs cause you constipation, which would worsen your fissure problems.

It sucks to have fissures, it is genuinely depressing and distressing.

Instead of pill popping, you need to develop mental strategies to help you cope with these problems, while you are working to get over the fissures. And let me let you in on something else: lbp35, you didn't do anything wrong. God isn't punishing you. Perhaps an incompetent surgeon has screwed you over, or an unethical one who didn't advise you of the risks is fully responsible for leaving you in this miserable state.

I think your therapist is an idiot who has no clue what it is like to endure this type of problem. To even dare suggest to you that you need meds because of your nerves, is to show not only how clueless your therapist is, but also insensitive to the level of pain and distress you are in. Your therapist might have helped you with some emotional issues in the past, but your therapist clearly shows she does not possess the understanding of how traumatic this surgery is, and is, therefore, in my opinion, not qualified to advise you properly in how to cope with your natural feelings of distress at the possibility of having to face another surgery. So if I were you, I would not discuss this problem with her as she is only going to give you an insensitive, and possibly needlessly dangerous, solution as she already has telling you to pop anxiety meds.

Honestly, if after going what I have gone through, and I had a therapist who told me she thought I needed meds to 'treat my nerves' rather than offering me support and methods to cope with the stress and distress, and meet face on and get through healing fissures, and possibly having repair surgery, I would ditch that therapist.

Don't take meds to turn yourself into a zombie to 'stop obsessing' about a genuine physical problem. Instead get pro-active to treat your fissures, and if that doesn't work, then use mental techniques to help you get brave to undergo repair surgery. Do you want to be a medicated, loopy idiot with painful fissures? Because that is what you risk popping anxiety drugs. Or do you want to be in control, trying different healing methods to get over your very real and painful fissures, and have a good chance of doing that, with all of your mental faculties intact?

I had a fissure 6 weeks ago that I healed. I just got a new cut 3 days ago during my transition off of colace and going to metamucil. The last thing I need to do is to pop meds that downplay my feelings of anxiety. Do you know that those are natural, good feelings that act as a signal from your body to make you act and do something now to heal yourself?

How did I get over my fissure? I used nifedipine cream 0.2% compounded by my local pharmacy for $45. I used this for 2 weeks, then followed with 4 days of elocon. I also took lots of colace and kept my stools consistently soft. The fissure healed. Technically, though, I should have kept up the nifedipine for a month, but I got lazy. I get awfully tired of having to doctor my butt, as I am sure you know what I mean.

Now I am doing the same thing for my new cut. I started nifedipine 3 times a day, with A&D ointment inbetween. I am still experimenting with the metamucil alone, without colace, as I am now almost 5 months post surgery, and am trying to go completely without colace. I am giving myself a week to fiddle with the metamucil to get it right.

However, if within a week I continue to have intermittent bouts of hard stools, I will add colace to soften my stools to get over this new cut. End of story. When I feel the pain of my cut/fissure which feels like alcohol on an open wound, I get genuinely distressed and depressed. What the hell is wrong with those feelings? Nothing, they are normal, and no way should you let anyone tell you that you need to medicate yourself when you experience such normal feelings of anxiety due to genuine physical cause. Your therapist has just earned the Turkey Award. Pass along the dressing, and we'll have Thanksgiving feast around her.
Quote from wjpjr:
Tammy, When you had your fissure did you have any pain?


Walt, like alcohol poured on an open paper cut. Very ouchy. That cream is nifedipine, and it has to be compounded as it is not available as a cream. It is compounded at the same strength as the nitroglycerin cream for fissures.

I had to call around my local pharmacies for one that does compounding, and then I had to argue with the pharmacist who wanted to sell me on a different cream used by a well-known hospital in my area. I firmly declined and told him I only wanted the nifedipine.

If you do a search online you will read some very uplifting information on the use of nifedipine cream for fissures. Do a search on nifedipine cream treating fissures and a couple of studies should come up on it. Generally it is used for 2 months for best results. I actually stopped at 2 weeks, shame on me, as I got lazy. Then I used elocon for 4 days. I've got a new cut now at the 6:15 position I have started to treat with the nifedipine, and have gotten good relief only 3 days into the treatment. My fissure last month was at the 6:30 position.

By the way, from what I've read, a fissure is a shallow cut, so I actually think most cuts in the rectum are considered fissures. But it makes me feel better to call mine a cut, as it doesn't seem so tough to heal when named that.

Lpb35, if you are reading this, the mental switchero I did to call my fissure a cut to make it easier to deal with mentally, is an example of a healthy mental coping technique, and that is what you need to develop, not pop pills instead!
Quote from Tammynoska:
Walt, like alcohol poured on an open paper cut. Very ouchy. That cream is nifedipine, and it has to be compounded as it is not available as a cream. It is compounded at the same strength as the nitroglycerin cream for fissures.

I had to call around my local pharmacies for one that does compounding, and then I had to argue with the pharmacist who wanted to sell me on a different cream used by a well-known hospital in my area. I firmly declined and told him I only wanted the nifedipine.


Tammy, Doesn't that cream need a prescription? I've been unable to convice any of the surgeons to issue me a script :(.

Your right about alcohol being poured on an open wound. That's what I've been experiencing for the past 2 and 1/2 months. Now I find out last Wednesday I've got not one be two. Double ouch!!

I'm pretty sure I can get it compounded at my local Echerd since they did the nitro for me this past summer. I could not use the nitro because of the headache side effect.
Quote from wjpjr:
Tammy, Doesn't that cream need a prescription? I've been unable to convice any of the surgeons to issue me a script :(.


Your surgeons are a bunch of control freaks. I am afraid it seems in their eyes, you have cried wolf one too many times, and they refuse to cooperate; or they are closed-minded, good ol' boys. You know what? It is a large world out there of doctors. Find a new one, make an appointment, come in there telling him you have a new cut. Don't mention your other surgeons refusing to give the cream, and tell him you have a pharmacy that will compound nifedipine in a cream of 0.2% for you, and ask for a prescription. At the same time, come in with a printout of the online study which shows nifedipine cream much more effective than nitroglycerin from this url--it's a adobe pdf file:

[url]http://www.facs.org/spring_meeting/gs06oliver.pdf[/url]

Tell that doctor you already tried nitro, but got severe headaches, and now want to try nifedipine, as you have acquaitances who have tried it with success, and not gotten any headaches. I really believe any reasonable doctor that does not have a past beef with you should glady write you a prescription, particularly after reviewing that pdf information.
Quote from Tammynoska:

In that context, God does not promise to make you happy in this world, to keep you free of grief, strife and suffering while you are on this planet as Walt, the human being. He does promise, through his Son, though, that if you keep your faith, inspite of these trials, to make you happy forever in the next world. Human life is fraught with terrible possibilities, ones that even make our experience in this recovery seem pale in comparison as far as the level of pain and fear.

You probably read my 2-cents on that therapist.


I hear you loud and clear about faith and therapist. I've always had a hard time comprehending how they can help more than some regular person willing to lend an ear other then being able to prescribe meds to put you in fantasy land. I don't really want to walk around like a zombie. I just want to heal and get my normal life back. I'm basically humoring my sister. It's amazing but do you know how difficult it is getting an appointment with ones of these therapist? More than half of this country must be seeking mental help since they are that busy. First you must be screened and that's if your lucky to get the phone answered.

[QUOTE]
Unfortunately you have to accept your family is a bunch of lunkheads when it comes to your problem, and stop trying to prove the severity of your problem to them, as it won't happen---they are intellectually dense about this, just as my family is. If you stop trying to make them understand, you will have less anxiety. All you have to do is schedule your meetings with them around your problem, or decline as I have had to do with my own family, since I still am nowhere ready to make long trips and participate in eating festivities because of my hair-trigger bowel functions that can occur at any given time, and leave me in pain afterwards.

Yep, family and friends eventually end up becoming lunkheads. I've already told my sister I'm not celebrating the upcoming holidays. All she did was hammer me about how my little nice would miss her uncle Walt at Christmas. Boy I love my sister but that seemed a little selfish. I sure would like to celebrate the holidays. We all certainly have not ask to be like this for god sake.

[QUOTE]However, sometimes I go 5 times a day, and that means 5 damn times having to clean myself out. I find that even if I clean myself right after going, about an hour later a new piece of fecal matter has come in contact with my cut, and I will be forced to get it out. I really believe you are suffering for the same reasons that fecal matter is scalding your cuts. The trick is to gingerly clean it out without aggravating your cuts.

I'm glad I only have one BM a day compared to yours. Not sure I could deal with more than one after the pain starts and things down south get tight. You may be right about keeping the cuts clean but I need something to help close them. I'm hoping this next surgeon gives me a script of nifedipine cream 0.2%. The nurse/scheduler indicated he does prescribe nifedipine. Although, she also mentioned the dread sphincterotomy word :(. Sorry to read about your new cut. Do you think reappearing cuts are going to keep occurring without surgery?

I'll keep you posted ... more good healing success with your new cut.
Quote from Tammynoska:
Your surgeons are a bunch of control freaks. I am afraid it seems in their eyes, you have cried wolf one too many times, and they refuse to cooperate; or they are closed-minded, good ol' boys. You know what? It is a large world out there of doctors. Find a new one, make an appointment, come in there telling him you have a new cut. Don't mention your other surgeons refusing to give the cream, and tell him you have a pharmacy that will compound nifedipine in a cream of 0.2% for you, and ask for a prescription. At the same time, come in with a printout of the online study which shows nifedipine cream much more effective than nitroglycerin from this url--it's a adobe pdf file:


Tammy - Right on and thanks for that pdf reference. I printed it out and have booked an appointment with yet another as&hole (no pun intended) surgeon this Thursday.
Anitraw, don't add raisin bran to your diet, if you are moving your stools okay. That is NOT a requirement, and you are right, it might backfire on you again like it did. I only didn't understand what you meant by not seeing an improvement. Listen, you have only been like 3 days trying to soften your stools and not reading on the toilet, so you have to give it time.

Don't freak out about bleeding. Yes, I bled for 10 weeks about a thimbleful of blood when I would go. I went several times a day; some of those times I would bleed if I had a somewhat hard stool, or if I had too much diarrhea, and sometimes I would not bleed. It did get better towards week 8, when I got my stools softer.

I am okay about having a cut now because it doesn't hurt that much, and when it does, I know how to quickly get it to stop hurting because that is always due to stool pieces irritating it. And I'm also okay with the cut, because I know that I can expect to get cuts from time to time for up to a year from stools too hard, which is how this new cut happened.

You have to realize that all of my surgery pain is gone, I am healed in there. This new cut hurt for the first couple of days, but I immediately started to treat it with nifedipine and a&d, and this immediate treatment seemed to quickly make it better. Plus, I am getting the metamucil trick better, and I had soft stools all day today. What I am going is about a scale of 0.5 compared to the 25 pain I had during my first 2 months. So these cuts later on, if you know how to treat them, are a drag, but manageable.

What you should do is not call your surgeon directly any more, as you are probably a basketcase each time you call, and I can see how that could wear down his openness to you. If you just schedule through his receptionist, and cancel through her, he shouldn't have any reasons to not want to see you. I made and recancelled my first post-op visit 5 times. I finally showed up for my first post-op exam 2 months after surgery, which is not really looked favorably by most surgeons, but I wasn't going to let anyone touch me down there before I was ready.
lbp35, first of all you have to rethink the healing time it takes for fissures. With medication, it takes an average of 2-4 months. Here you have tried something for only 2 weeks, and you are distressed your fissure didn't heal. You have to stop thinking of your fissure like a regular cut that heals in 7-10 days. That doesn't apply to fissures generally.

Second of all you NEED to read this file:

[url]http://www.facs.org/spring_meeting/gs06oliver.pdf[/url]

It details the prescription med I am using call nifedipine you asked me about, and gives full details about how long it takes to work (average 2 months), and how effective it is versus other treatments, including surgery.

Education, lpb35, you need education on what you are dealing with.

Next you need to stop the vitamin e oil pronto. Vitamin e oil can cause increase bleeding, and studies have shown it not to help scars soften...but, most of all, vitamin e oil therapy is meant to apply to scars---scars, not open wounds. It has been shown that ointments, like the over-the-counter antibiotic ointments, can slow down healing considerably. Putting an oil on it can also slow down your healing.

I suggest you first rethink what is a normal time it takes for ANY therapy you use to work effectively. 2 months minimum. I never used the diltiazem, and haven't heard about using this for a fissure, so I have no comments on it. Why your doctor would give this to you to heal a fissure, I don't know.

I have to tell you that that nifedipine cream has given me good results in 2 weeks, but it is meant to be used for 2 months to really get rid of the fissure. I think that study above also compares botox to nifedipine and shows the nifedipine to be more effective.

If I were you, I would ask your doctor to prescribe the nifedipine cream at 0.2%, and give it a real try for 6-8 weeks. You use it 3 times a day, putting in a pea-size of cream each time. You absolutely do NOT rub it into your fissures, or rub your fissures at all, as this rubbing can reopen your fissures minutely, slowing down healing. You just dab it on.

My new cut I got last week doesn't hurt with bms, and no longer feels sore, because I think it is responding well to the nifedipine. However, I also make sure not to touch, prod, poke, or stretch my cut at all, as I know these actions can pull it open and slow down the healing. You should stop doing that too.

Finally, you can't get your fissure to heal like a cut; you can though, get it to heal like a fissure, which usually takes 2-4 months. No matter how much you try, you will not get it to respond like a normal cut and heal in 7-10 days. Relax, change your frame of healing time reference, and give the nifedipine a try.

You will have to find a pharmacist in your area that can compound this for you, because it doesn't come readily available and has to be made. It cost me $45 to have a tube made; I don't know what your pharmacy would charge, you have to ask.
[QUOTE]
I never used the diltiazem, and haven't heard about using this for a fissure, so I have no comments on it. Why your doctor would give this to you to heal a fissure, I don't know.
[/QOUTE]

This is interesting. I saw the surgeon I had my second opinion from back in October. I went because the appointment was a day earlier than tomorrows. Back in October he said everything looked fine even though I was complaining about like sitting on glass and standing with a broken bottle shoved up my a%ss. Well today he said I have a really big fissure. I still believe there are two but he only spread my butt cheeks a little and observed the big post-anterior one. The other fissure was diagnosed as being anterior by the surgeon I saw last week. Since he did not perform an inside look I suspect that is why he didn't see it. I brought up the use of nifedipne ointment but he has not use it. He prescribed the same diltiazem 2% cream lpb35 is using. He indicated only a 30-40% healing success rate :(. He did think I should see some relief. I suspect more surgery will be needed down the road. My minor problem has just tuned major with a capital M. Its really going to be hard coming to grips with yet more surgery and starting this cycle all over again. The diltiazem has to be compounded so I won't get it until lately today from the pharmacy.

Now the big question. Should I keep the appointment tomorrow with a surgeon known to use nifedipine? Or should I give the diltiazem a chance?

How do you manage to stay active and keep off your butt while you heal your fissures? Mine might be a little worst than yours because I'm in constant pain and agony. I use to get a little relief at wake up but even that has all but diminished.

My advice for anyone contemplating surgery for hemorrhoids is "tread lightly with extreme caution". You may end up with more problems than you began with. I have never had fissure problems in my life. But now I end up with two.
lpb35. yes, I think it is a bad idea to use the vitamin e. First of all that is why my last hemorrhoid bled so badly, because I used vitamin e oil on it, and it caused me to have super bad bleeding, and for the other reasons I told you. And just think about it: why would a doctor who does laser surgery on anal fissures recommend vitamin e if it worked and kept new patients coming to him for laser surgery? I think because it doesn't work, and he feels confident you will come back.

And for the same reason, I wonder about your surgeon giving you a drug that has poor track record of healing fissures? Again, in confidence you will come back for surgery and bring money to her that way?

If you think you won't get discouraged trying that diltiazem for a few weeks, then give the nifedipine a try, then do it. I just don't know why no one here is bothering to try the nifedipine. My new cut no longer even bothers me, and that is just after 5 days of using the nifedipine. I plan on using it for a month, but I have had fantastic results with this.
Quote from Tammynoska:
I just don't know why no one here is bothering to try the nifedipine. My new cut no longer even bothers me, and that is just after 5 days of using the nifedipine. I plan on using it for a month, but I have had fantastic results with this.


Tammy, Its not like we don't want to try it but most surgeons (at least mine) don't seem to want to prescribe it. It would be nice if nifedipne didn't need a script but alas it does.
Walt, I know about your surgeons' refusals, but your wrote a couple of days ago that you had an appointment with a new doctor, and were going to try that one for a prescript, and were going to go armed with that pdf printout. Have you tried that one yet? I just don't know why these surgeons of yours don't want to prescribe the nifedipine, unless they are worried the nifedipine works too well and will keep you from being a paying surgery patient.

My surgeon didn't have a problem prescribing it, as it is along the same lines as the nitroglycerin, but doesn't give the headaches and has a much higher success rate. I have had no side effects at all with it either of any kind, so I am very happy with this. The nurse told me I may get low blood pressure, but that hasn't happened in over a month---I make surre not to use more than a BB size dose, and that seems to work well. I would seriouslyl question the motives behind your surgeons refusal to let you try this treatment.
Walt, first of all yay on the open-minded and honest surgeon! Finally!

As far as the sitz baths---for a person still recovering from their hemorrhiodectomy surgical wounds, I would absolutely tell that person to at no cost take any warm or hot sitz baths.

But, you are now fully healed from your surgical wounds. What you are experiencing are new cuts that are a complication to the raised scar tissues, so I don't think warm sitz baths would harm you. Only I would avoid hot hot ones, as you don't want to draw too much blood and maybe inspire a hemorrhoid (I don't know if that could happen, but I would be careful of that).

In your case, maybe even adding a bit of epson salts might help.

Just be sure to be religious on your application of the nifedipine, 3 times a day, about a bb size on the area, and to be careful not to stretch apart your fissures when you apply the cream.

About 2 hours after I apply the nifedipine, I then dab the vitamin A&D ointment to help keep things soft, just a bit, like bb pellet size.

Good luck, I hope this regimen helps. I, like you, have no stomach for another surgery.
[QUOTE]Walt, first of all yay on the open-minded and honest surgeon! Finally!

Only I would avoid hot hot ones, as you don't want to draw too much blood and maybe inspire a hemorrhoid (I don't know if that could happen, but I would be careful of that).

In your case, maybe even adding a bit of epson salts might help.

Just be sure to be religious on your application of the nifedipine, 3 times a day, about a bb size on the area, and to be careful not to stretch apart your fissures when you apply the cream.

About 2 hours after I apply the nifedipine, I then dab the vitamin A&D ointment to help keep things soft, just a bit, like bb pellet size.

Tammy, exactly what I thought. I have the nifedipine now. I about to apply the first application. I follow up with one right be bedtime today. Tomorrow I'll do morning afternoon and night. The surgeon told me only twice daily though?

What was yours compounded with? Mine has 0.2% nifedipine together with a petroleum jelly base if I remember the script correctly.

I'm with you on those sitz baths. I'm still leery of the outcome. But I want to do all that I can at this point. I really want these damn cuts healed without constructive surgery. I know it's going to take time.

BTW, I'm not sure I have the right A&D. Mine says "A+D Original Ointment for Diaper Rash". It has 53.4% Petrolatum and 15.5% Lanolin.

I like your post on how to make soft and moving stools. You got the beginnings of a book :).
Tammy, I'm having a little difficulty judging the right amount of nifedipine. The first dose I apply last night gave me a moderate migraine. The migraine could of been coming on ayway -- hope so. I cut back a little when applying the bedtime one and this mornings. I did not get a headache but I'm not sure I yet have the right amount. Unfortunately, the container the pharmacy placed it in was not a tube like the diltiazem the other pharmacy did. I'm trying for the bb size. The first time I dabbed my pinky finger into the ointment to gather up a little. With the next applications I used the wooden end of a q-tip to dip in and dab that on my pinky finger before gently dabbing on my butt area. What's your technique? Do you get in your three ring circus position like applying gota kola?
Walt, I'm really sorry about taking so long to reply, but this is the busiest time of the year for me, and I am crushed with work. I won't be able to respond properly until after Thanksgiving weekend.

Any rate, quickly, that A&D ointment is not the formula I use. Mine is:

active ingredient: white petrolatum 72.7%
inactive ingredients: anhydrous lanolin, light mineral oil, petrolatum, vitamin a palimate and vitamin d.

I found that the ingredients DO make a difference.

This particular mixture once was sold by Eckerds drugstore, but it seems that they lost or gave up the manufacturing of it. I went desperate trying to find it, then learned that CVS Pharmacy now was putting out their own brand with the identical ingredients. It did turn out to be exactly the same one. CVS doesn't call it A&D ointment, thought, but Protective Ointment.

Also, I don't know why your doctor gave you the nifedipine as an ointment. Everywhere I read the nifedipine was given as a cream. Will this make a difference?

I don't know, but I do know that I have not had the same results with other medicines that I had used as creams that were given to me identical strength in ointment form, such as elocon. The ointment version of elocon doesn't cut it for me.

Also, I don't know if in ointment form the nifedipine will inhibit healing or not?

Still everywhere I read, and according to my doctor, the nifedipine should be put on the same amount of times per day as nitroglycerin cream for fissures, and that is 3 times a day, spaced out, so always some nifedipine is working on the fissure.

As you figured out, I used a small BB size dose. You shouldn't use a penny-size or larger, or you may experience bad side effects of nifedipine, and it won't make your fissure heal any faster. If you posted any other concerns, I haven't had the chance to read, and will get back to everybody later this week.
Quote from Tammynoska:
what strength of Colace are you taking when you take the 2 at a time?

Also, are you drinking right with the colace 10 ounces of water or more? I found that if I popped colace and had 8 ounces or less of water, the colace wouldn't work well. I also found that I had to follow an hour later with about 10 ounces of water.

Okay, now did you know that bananas can constipate? I would cut that out at your breakfast for now.

1 tablespoon metamucilI take the brand metamucil and the dose is only 1 teaspoon.?


Tammy, first off thanks for posting back in your busy season. Bananas have not seem to effect me. I mainly eat them to get some potassium. Only only recently added the bran waffle and only on the weekends. Before the bran one I was eating a regular Kellogg's low fat one. I added the bran one since it has more fiber content.

I use the brand colace 100mg. Yes, I take the colace with two 10oz water.

I take the brand "metamucil" and the instructions printed on the label clearly indicate the adult dosage to be one round tablespoon up to 3 times per day.

Yep always drink adequate water when taking the metamucil wafers. Also drink plenty of water throughout the day.

I use the bread mainly for fiber content. Yes, the label says "enriched whole wheat flour". WIthout the bread I'm at a lose for a lunch time meal.

I usually eat the potato skin and I don't have one everyday. Usually only once per week.

Yes, I realize dairy can lead to constipation and for that reason I only eat those as low fat and in moderation.

I had been using one surfak daily before the surgery and continued but added the addition of colace.

Yesterday I cut out the morning dosage of metamucil and eliminated the colace at dinner. Only used the surfak and metamucil at dinner. This morning my stool was still mushy an self moving. I did not experience the cramping today I experienced the last several. I'm thinking the cramping resulted from the combining of colace with surfak. I'm going to try substituting two 100mg colace for the one 240mg surfak.

[QUOTE]I don't know why your doctor gave you the nifedipine as an ointment.

How he wrote the script is the way he always compounds it.
Quote from anitraw:
Walt- I am glad to hear that you are going to have some time off I think that you right about it being a blessing. I hope that with this time off your fissures start to heal up and you can start to get on with your life. I hope you have a nice holiday and can enjoy some of the food and fun. Take care.


Anitraw, Boards seem to be very quite all of a sudden. That means either others are getting better or loosing interest. Unfortunately, I don't seem to be getting any better. The one fissure I'm battling has tuned into to a very painful ulcer. This is right on the skin leading into my butt hole. Because of the location it becomes extremely difficult to sit and even stand. Neither of the ointments diltiazem or nifedipine have helped much.

I start to see each of the three colo-rectal surgeons this week. Not sure what they are going to say or do but living in my current condition is a living hell. I doubt I'll be celebrating the holidays this year. It's a struggle just getting through each day. I'm afraid more corrective surgery is in my future :(.

I hope you are doing well and soon will have yours behind you. Take care ...