First, thank you for your web page. I don't normally have anything to do with self help groups of any sort and read everything else on the web that I could find about anal fissures except your page to begin with. I ended up on your page accidentally, was fascinated and amused and went home singing its praises. I am still working my way through all the accounts and the links. I've learned a great deal, I know there are lots of other people who've been through what I am and am encouraged by their success. I guess you deserve any fan mail you get.
I don't know if my account is different enough to include, but in those accounts I have read I didn't see any mention of Diltiazem. It may have a different name in the USA, or maybe you actually don't have any feedback yet.
I am a 30 year old woman in England. I got my anal fissure almost a year ago (September 2005), very shortly after I was diagnosed with Type 1 Diabetes. No, I don't see any connection except possibly my generally weakened state and bad luck mostly (4 months previously I needed surgery for a badly impacted wisdom tooth which had developed an infection - not a good year!). It's possible the fissure might have healed itself, had my blood sugar not been too high, but it was months before I was at normal level and by then the fissure must have been chronic.
I had no idea what was wrong, just started having pain and itching, some days worse than other days. My pain threshold is very high and my embarrassment threshold is very low. Besides, I had plenty to occupy me learing to cope with multiple injections of insulin and feeling still pretty awful for several months after diagnosis, so I did not go to the Doctor. My motto is usually if you leave something long enough it will go away by itself (the Diabetes didn't unfortunately) and I waited for the pain to go away. It got worse instead and began to take over my life, in the same way everyone else has described. The first few minutes after every bowel movement I was virtually paralysed with pain, couldn't move at all, and for another ten-fifteen minutes afterwards was still in such excruciating pain I felt physically sick and thought I would throw up. After that passed I was 'just' in bad pain for the next five hours. I couldn't sit, walk, cough etc etc. For the first couple of hours I often couldn't urinate at all or had difficulty. I'm sure everyone else knows it all. I put up with it for almost six months until the near constant agony finally wore me down to the point that I was thinking suicidally and I was almost incapable of functioning at work. Then, in February this year, I gave up and spoke to my Doctor.
The visit actually was as embarrassing as I had dreaded and may I never have to go through that again. However, he examined me and said that I had a very large anal fissure. He then wrote out a prescription, handed it over and dismissed me. He didn't explain exactly what an anal fissure was, made no mention of its causes, told me nothing about whatever he had prescribed - how it worked or how to use it, didn't say how long it should take for the fissure to heal or anything else that might have helped. When I asked if fissures went away by themselves he did say not without treatment but that was all the information he gave me.
The prescription turned out to be for a Diltiazem ointment which needs making up as a special so it came with no instructions or information and I had no idea what to do with it. All it said on the label was to apply to affected area twice a day. I wasted four weeks getting nowhere because I didn't know what I was doing. I tried to get the ointment actually inside (where I imagined the fissure was) and it just made the pain worse. I put it on when it was hurting, after I'd visited the bathroom etc to no avail.
After four weeks, I finally found the time to do some web searches and found several sites which explained what a fissure was, what caused it and the options for treatment. I discovered that the pain was caused by muscle spasm etc and, more importantly, that Diltiazem relaxed the muscles (without the side effects of Nitroglycerine, the other popular form of treatment) and helped healing that way. I also found somewhere something about putting ointment just outside the anal entrance, not actually inside, and somewhere else that it should be put on before a bowel movement. With that information to hand, I started putting the ointment on at 6:00am immediately after I got up, so it would have had plenty of time to work before I used the bathroom usually about 8:00am. I also started putting it in the general vicinity (instead of trying to get it inside) which wasn't painful at all. I also put it on at night, as per the instructions on the jar of twice a day) just to keep the muscles relaxed as often as possible.
Well, it worked. I finally stopped having such pain and began to have a life again. The bowel movement itself was still painful at the beginning but the agony afterwards was usually a thing of the past. The exceptions were if I was unlucky enough to need to go too soon after applying the ointment. Putting it on afterwards is not as effective and takes an hour until I notice any difference at all. The other exception was if I had diarrhoea which gave pain because if irritated the fissure not because of spasm and wasn't helped by the ointment. By keeping faithfully to this routine the fissure began to heal nicely and I got to a point after a couple of months where even the bowel movement itself wasn't painful and I hardly had any trouble ever.
Unfortunately for me, in June I had an episode of dehydration (Diabetes related) which led to a bad bout of constipation, during which I felt the fissure rip right open again. Back to square one and I'm still furious! Since then I have continued to use the Diltiazem and don't have much pain very often, but the fissure is not healing the way it did the first time. I am not giving up. Fortunately I get free prescriptions on the National Health Service because I'm diabetic so I can keep getting more and more of this ointment for as many years as it takes without it costing me anything. Sure I want the fissure to heal but I don't feel the same urgency because the pain is nothing like what it used to be. I read that surgery has a risk of incontinence so I'd rather not ask for it unless I really have to.
On my pharmacist's advice, I am now taking a stool softener regularly in the hope that it will help. I am also reading anything I can find on avoiding constipation, which has been a problem since I was quite young. I eat a sensible diet and cannot revamp it to the degree some of the accounts on this page have done. It took the hospital 11 months to get the right dosage of insulin to keep me at a level which satisfies them and me and, having finally achieved it in August, I am not about to make major changes in my life which will necessitate another 11 months of adjusting. I hope, eventually, with the help of pages such as these, to work something out and see the fissure as history. Meanwhile, I thank G-d for Diltiazem and go on living.
I did a web search on Diltiazem and found this at the National Institute of Health website. Jack
Diltiazem is used to treat high blood pressure and to control chest pain (angina). Diltiazem is in a class of medications called calcium-channel blockers. It works by relaxing the blood vessels so the heart does not have to pump as hard. It also increases the supply of blood and oxygen to the heart.
I asked for more information on September 07, 2006 and this is what the patient wrote back:
Technically, I don't know much about Diltiazem except that's it's a calcium channel blocker, used orally for blood pressure patients and it relaxes the anal muscles, but I can tell people which web sites I looked at. I also have a pharmacist who is much more helpful than my GP and may be able to get some more info. for me if I ask nicely. I can also give people the exact description of the ointment I have, from the label of my jar, if they want to know. (As an aside, it also contains Lidocaine which has no effect whatsoever on the pain.)
In response I asked how about writing up this information and sending it to me and I will include it with your report? This way, everyone will have access to the information. The patient wrote back with:
By all means include the information in the account and save people time and nuisance. With any luck they'll be hammering their doctor's doors down asking for Diltiazem. I should buy shares in the pharmaceutical industry.
The following links are sites which are quite informative. I have put them pretty much in order of usefulness. The first actually tells you how to use Diltiazem ointment - amount and method and you don't have to read through any other pages before you get to the paragraphs concerning Diltiazem. The others mostly just give info. about how it works and the results of studies carried out. Together, they are fairly comprehensive and should tell people everything they need or want to know.
My jar label reads 2% Diltiazem Hydrochloride, 5% Lidocaine in Yellow Soft Paraffin. The study referred to everywhere seems to have been 2% Diltiazem. This must be standard. The ointment is meant to be discarded after four weeks but I have usually used it longer than that without noticing any difference, while I waited for another prescription for some more.
My advice to anyone applying it is to use a Q tip (cotton bud) with a blob of ointment about 2-3 times the size of the end of the Q tip. If anyone has trouble with this, try wrapping a plastic sandwich bag very tightly around a forefinger and applying the ointment that way. It's horrible to get the stuff off fingers as I have discovered when a little has accidentally got on my hand.
I think all the above should be sufficiently helpful.
Have a good day.
Feel free to contact me (patient 63) via email about Diltiazem ointment.