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He prescribed Anusol HC suppositories for 2 weeks with a refill of another 2 weeks if necessary.

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In addition, tolerance to nitrates is well recognised and this may be a problem with their use for treatment of fissures.

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Maturanza M, Maitato F, Costanzo A, Pavero R, Battistini G, Minerva Combined outpatient surgical -cryotherapeutic treatment of anal fissures.

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Roberts RJ, Blumer JL, Gorman RL, et al "American Academy of Pediatrics Committee on Drugs: Transfer of drugs and other chemicals into human milk.

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Surgical versus chemical (botulinum toxin) sphincterotomy for chronic anal fissure: long-term results of a prospective randomized clinical and manometric study.

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You obviously need a GI doc to do an anoscopy and a digital exam (if not too painful).

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Atypical fissures warrant a complete medical workup and often require an examination under anesthesia, with biopsies and cultures.

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Lateral sphincterotomy results in a discrete defect of the IAS; in women, the extent of the division can be greater due the relatively shorter anal canal length ().

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Diltiazem (Cardizem) is a calcium channel blocker used to treat hypertension (high blood pressure), angina (chest pain), and some forms of irregular heart rhythms.

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In this study of 80 patients, the maximum number of patients with chronic anal fissure was between 31 and 40 years of age, the youngest subject being 17 years and the oldest 78 years.

In patients with atrial fibrillation or atrial flutter, diltiazem systemic clearance has been found to be decreased compared to healthy volunteers.

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Just had my second Sphincterotomy Surgery done four days ago, the first one was done 3 years ago, I have IBS ( or so the doctors say ), So over usage of the area caused fissures which were very painful, I feel like I was hit with a baseball bat several times plus I also have the feeling of an ice-pik inside of my anus, Don't know if this is a condition which will continue seing that my stomach alwas wants to push my food down and my bottom's in pain and sometimes can not be in synch.

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Oral diltiazem has been assessed as part of a randomised trial and shown to heal anal fissures; however, significant side effects were noted.

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These medicines work by relaxing the smooth muscle, allowing the fissure to heal.

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Study treatment will be applied in and around the anus, three times daily, for up to 8 weeks.

Drawbacks: The most common complications encountered are bleeding needing hospitalization, abscess and fistula formation, incontinence to flatus and feces, and recurrence.

Seventeen patients who did not heal were treated for a further 8 weeks with topical diltiazem.

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Physicians in England developed the treatment, which gained acceptance in Australia and finally in the United States.

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