At a pharmacy and therapeutics committee meeting about 2 years ago we discussed topical NTG for rectal use. At that time no NTG product was manufactured with a low enough concentration. Patients were basically given an Rx for a tube of 2% NTG (aka Nitropaste) and an Rx for some petrolatum or other base and instructed to mix it to achieve the desired 0.2% concentration. The pharmacists were concerned about the patient's ability to compound the mixture and the facility's liability if the patient did not follow the directions. Are you aware of newer products that are manufactured at the 0.2% concentration?
Oh, how to joke about it all, let me count the ways...
I have to ensure that patients go to a pharmacy that will make the preparation for them; I don't know of any commercial preparations.
Having once been a fellow sufferer, I am most interested in the NTG therapy. (I survived with stool softeners & fiber & time). But, having much sympathy for my fellow-suffering patients, I'd beinterested in the sig for the NTG. Is it bid, tid, prn?
The NTG is applied BID, and you have to be sure it is the 0.2% ointment rather than the more commonly used 2% (used for cardiac patients).
thanks muchly!
fiber products don't work for everyone. It doesn't matter HOW much I drink, they make matters worse. Think concrete.
Dried apricots, OTOH, are much more successful.
If I ever develop a fissure, I hope I remember this study. Avoiding surgery at all costs is very high on my agenda.
I generally prescribe the 0.2% NTG, with a ~50% success rate. No experience with botox. Most of my local pharmacies will mix the standard 2% stuff down to 0.2%, but I know of 2 patients that have received the full strength stuff (they showed me their tubes). Talk about headaches- almost worse than the fissure. I am very careful to make sure that I write the 0.2% very legiblely.
Has this type of regimen been considered or tested on related conditions? I have a recurrent fistula that has been operated on 14 times, the last time it was cauterized and is about 50% closed. Much better, but still potentially embarrassing. I went to the extent of having an ileostomy for 4 years to "allow it to heal", but that herniated, got gangrene internally, and almost killed me. NIX the ostomy... So the question is, are there any new developments on THAT front -er... back?
Desperately in search of new NON-SURGICAL solutions....
Elizabeth
I have solved my own anal fissure simply by the way I sit on the toilet. I had a fissure for about 6 months. I realized that I arched my lower back which caused the colon to "arch". When I round my lower back out, the bowel exits out more straight versus scraping/rubbing against the posterior part of the colon/sphincter. As soon as I started doing this, the fissure was gone in a week or so...so the trick (at least for me) was to round the lower part of my back (like the scared cat position in yoga but instead the lower back). To avoid future fissure, I continue to use this technique. Hope this helps some of you!
stitches
quick and easy sewture
I've discovered that I have fissure(s). My first dr's appt is in 2 more weeks. Let me add that I am virtually never constipated. Instead, I have chronic diarrhea, that is at times urgent. I've seen this linked with fissures in a few places. This is surely a case of hell on earth.
I've started all of the non-medical approaches, and hope like heck to avoid surgery. If I still have this problem by the time of my doctor's visit, then my attempts to self-treat will not have succeeded.
Considering that I had the condition several weeks prior to calling for an appointment (finally calling after using a mirror), and that was a few weeks ago, I am not optimistic.
Hey, I was searching the net for info about home treatment of anal fissure and I found this info - it sounds quite reasonable:
http://www.anal-fissure.net/home...home-treatment/
I have been suffering from CAF for almost 2 yrs-result of a traumatic child birth. My doc has tried every regimen in the book except surgery. The latter according to my doc is not a viable option for me as I hardly have any sphincter left. after being on a conservative therapy for the longest time, finally underwent botox Rx. Thus far, no signs of improvement. I have been religiously doing sitz baths with epsom salt and taking miralax. I don't understand why docs attribute everything to constipation. If normal bowel movement is constipation, then how does one define constipation. I don't find the stool softeners to be very effective, if anything they increase the frequency and that wears me out and the pain starts all over again. The latest I am on is Lidocaine-too early to say if it helped in any way. The only thing that has helped in some way is taking rest and doing nothing, which unfortunately is not a feasible option for most of us. So, I am waiting for a miracle to happen as there are days I think I'll die of the pain but won't
I have been suffering from cronic fissures for 3 years and nothin works I've had the surgery and all the oitments and all the home remedies I'm thinking about tying Botox does anyone have any info on that ... I feel like I'm paralized by these fissures I can't work I can't function I feel like I could actually die from the pain
I have had a recurrent anal fissure for almost 10 years now. I've tried all non-surgical avenues (except botox) and found nothing worked on a long term basis. I have maintained a strict high fiber diet (don't eat red meat either)I was not going to do ointment every day for the rest of my life and it seemed hit and miss with it's efficacy anyway. Then I started taking a probiotic after having a course of antibiotics. This improved the consistency of my stool and healed up the fissure within a couple of weeks. This probiotic, InLiven has helped with other health problems and cleared up my skin too, it's so good I sell it now and continue to take it every day. Best of all it is certified organic and is a living whole food. Email me for more info and I can explain how a probiotic can help with digestion and elimination of waste.
I just had the fissure surgery yesterday after suffering for 4 years.
I had healed the fissure once before by drinking lots of water (I was dehydrated which led to constipation).
This time around, drinking water did not help so I took the surgery route.
Thank you for all of your tips-- anything that alleviates the pain is appreciated.
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