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Dr. Bob
Dr. Bob, Medical Doctor
Category: Medical
Satisfied Customers: 5118
Experience:  20 Years in Internal Medicine, Neurology and Sports Medicine
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GP symptom diagnosed anal fissure. Seems to be inflamed

Customer Question

GP symptom diagnosed anal fissure. Seems to be inflamed hemmorhoids internal. After bout of diarreah. Started with lots of water, and good diet. *Menopausal so cannot tolerate dairy any longer... chocolate milk shake was the culprit. Only slight bleeding at first then none, no history of this or of other bleeding, Can pass movements ok but pain and spasms after, started nitro about 6 weeks ago seems to be helping but still not gone yet. Taking a long time, I am 58. Really would like to get things back to normal but seems like there are better days but then a painful days tigtness in schincter present but spasms not as intense. pretty much always there in some form, tissue seems inflammed and swollen. Do NOT want surgery and can tolerate the ntiro but very slow process???
Submitted: 2 months ago.
Category: Medical
Expert:  Dr. Bob replied 2 months ago.

Are you keeping your stools soft?

Customer: replied 2 months ago.
for the most part too much fiber inflates no prblem with constipation
Customer: replied 2 months ago.
just trying to get the insoluable fiber and soluable figured out... typically eating fish, veggies, chicken carrots, oatmeal flaxseed etc.. new good diet.
prior to not so much...
Customer: replied 2 months ago.
had the incident seemed better on and off but continually sat for long periods went to dr at 4 -6 weeks started nitro at 7 weeks took time to get it .04 nitro compound 2 times a day and now on it for about 6 or 7 weeks, applying small amount topically. (not insert)
Expert:  Dr. Bob replied 2 months ago.

Well, obviously it it very important that you avoid straining, as this increases swelling in the anal canal due to increased blood flow, narrowing it, and making it more likely that the stool will keep reopening the fissure. Straining also increases muscular tone in the canal, putting further pressure on the fissure. So it is best to keep the stool with form, but loose, and allow it to come out on its own timeframe. ANother thing you could consider is inserting a suppository just prior to any bowel movement. Some people use glycerin suppositories, some use hydrocortisone ones (with an anti-inflammatory). This can help to prepare the anal canal for the stress of stool passage.

Customer: replied 2 months ago.
Are these over the counter or prescription? and can you use in conjunction with using the nitro?
Expert:  Dr. Bob replied 2 months ago.

These suppositories are available over the counter. They can be used with nitro but are best used at least 2 hours before or after.

Customer: replied 2 months ago.
Well pretty regular but if it is a fissure seems to high up so not sure if the nitro is reaching it, but was told by pharmicist it travels well topically to relax the blood vessils allowing better blood flow to help heal. and typically it states 6-10 weeks on nitro to heal but could be longer everyone is different.. is 10 weeks on nitro long?. I have not estrogen i suppose....???
Expert:  Dr. Bob replied 2 months ago.

Total healing may take 10 weeks, but improvement should start within a few weeks. The amount of nitro used is typically small and does not get into the bloodstream much, so it is usually safe to use. However, if you are not placing it into the canal then you are not benefitting from the lubrication effect. If your doctor or pharmacist instructed you to not put it into the canal, then you can use the glycerin and/or hydrocortisone suppositories for this purpose.

Customer: replied 2 months ago.
The nitro I'm told us to help heal the fissure by relaxing the schincter spasms so has a different role it seems but once fissure heals spasms should end it is better but only about 50 percent possible to need another round of treatment again after this?
Expert:  Dr. Bob replied 2 months ago.

Yes, you should treat or retreat until it is 100 percent better, unless your doctor tells you otherwise.

Expert:  Dr. Bob replied 2 months ago.

If you treat the spasms and the inner inflammation at the same time, it should heal faster, as they are inter-related.

Customer: replied 2 months ago.
nitro and lidocaine ? Typically or recticare or the cortisone ?
Expert:  Dr. Bob replied 2 months ago.

Yes, you could alternate nitro and cortisone. You could also use lidocaine as directed for pain when needed.

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