Understanding Diltiazem Ointment for Fissures
An anal fissure is a small tear in the tissue lining the anus, often caused by hard stools. This can lead to pain and muscle spasm in the internal anal sphincter, reducing blood flow and hindering healing. Diltiazem, a calcium channel blocker, relaxes this muscle, increases blood flow, and aids healing. It is typically used topically for localized treatment.
A Step-by-Step Guide on How to Apply Diltiazem Ointment
Correct application of diltiazem ointment is vital for hygiene and effectiveness:
1. Preparation
- Wash your hands: Clean hands thoroughly with soap and warm water before and after application to prevent infection.
- Use protection: Wear a finger cot or disposable glove.
- Find a comfortable position: Lying on your side with bent knees can help relax the area.
2. Application
- Use the correct amount: Apply the amount recommended by your healthcare provider.
- Apply gently: Insert your finger or an applicator gently, no further than the first joint, into the anal canal.
- Target the area: Apply the ointment around the inside of the anal canal, focusing on the fissure area. If pain is severe, apply externally around the anus.
3. Post-Application
- Dispose of equipment: Safely discard the finger cot or glove.
- Wash your hands again: Repeat handwashing.
4. Frequency and Duration
- Follow your doctor's instructions: Apply as prescribed, typically twice daily.
- Complete the course: Continue treatment for the recommended duration, often 6-8 weeks, even if symptoms improve.
Managing Potential Side Effects
Topical diltiazem generally has fewer systemic side effects, but headaches and local irritation may occur.
- Headaches: These may decrease over time. Simple pain relievers like paracetamol can be used if approved by your doctor. Applying at bedtime might help.
- Local irritation: Cool baths or showers and gentle cleaning can help.
Contact your doctor if side effects are severe or persistent.
Comparison of Topical Diltiazem and Topical GTN
Topical diltiazem and glyceryl trinitrate (GTN) are common treatments. Here's a comparison:
| Feature | Topical Diltiazem (2%) | Topical Glyceryl Trinitrate (GTN) |
|---|---|---|
| Healing Rate | Comparable to GTN. | Comparable to Diltiazem. |
| Headache Incidence | Significantly lower. | Higher, leading to discontinuation in some cases. |
| Recurrence Rate | Associated with lower recurrence. | Can be common, around 50% in some studies. |
| Primary Mechanism | Relaxes internal anal sphincter by blocking calcium influx. | Relaxes internal anal sphincter via metabolites. |
Supportive Care for Fissure Healing
Supportive measures can enhance healing and prevent recurrence:
- Increase Fiber and Hydration: A high-fiber diet and plenty of water soften stools and reduce straining.
- Sitz Baths: Warm baths can soothe the area, reduce muscle spasm, and improve blood flow.
- Avoid Straining: Do not strain during bowel movements to prevent re-injury.
Storage Instructions
- Store at room temperature (below 25°C or 77°F) away from heat, light, and moisture.
- Keep the tube tightly closed and out of reach of children and pets.
Conclusion
Topical diltiazem ointment is an effective and well-tolerated non-surgical option for many with anal fissures. Following correct application, duration, and supportive lifestyle changes can significantly improve healing and relieve pain. Consistent application, as directed by a healthcare provider, is crucial. For resistant cases, a colorectal surgeon may be consulted.
