Understanding How Nitroglycerin Ointment Works
Nitroglycerin ointment is a prescription-only medication used to treat the pain associated with chronic anal fissures. An anal fissure is a small tear in the delicate tissue lining the anus, often caused by straining during bowel movements. The resulting muscle spasms in the internal anal sphincter can restrict blood flow to the area, preventing the tear from healing.
Nitroglycerin belongs to a class of medications called nitrates and acts as a vasodilator. When applied, it relaxes the smooth muscle of the anal sphincter, which helps to increase blood flow to the area. The improved blood circulation reduces the pressure and spasm, creating a more favorable environment for the fissure to heal.
The Step-by-Step Application Process
For optimal results and to prevent the medication from being absorbed through your fingertips, a precise application technique is required. Always follow the specific instructions from your doctor or pharmacist, but here is a general guide:
Before You Begin
- Gather your supplies: your tube of nitroglycerin ointment and a finger covering (such as a disposable surgical glove, plastic wrap, or a finger cot).
- Wash your hands thoroughly with soap and water to ensure the area is clean.
- Ensure the area around the anus is clean and dry. A sitz bath beforehand can be soothing and may help relax the muscles.
Measuring and Applying the Ointment
It is crucial to follow the specific dose prescribed by your doctor or outlined in the medication's instructions.
- Place a finger covering over your index finger.
- Refer to the measurement guide provided with your medication, which often includes a dosing line.
- Position your covered finger alongside the dosing guide.
- Gently squeeze the tube to express a line of ointment onto your covered finger, matching the prescribed amount.
- Gently insert the covered finger into the anal canal, no further than the first finger joint.
- Carefully smear the ointment around the inner sides of the anal canal.
If Insertion is Too Painful
For some patients, insertion may be too painful due to the severity of the fissure. In this case, you can apply the ointment directly to the outside of the anus. While not as direct, this can still provide therapeutic benefit by allowing some absorption.
After Application
- Immediately dispose of the finger covering in the trash.
- Wash your hands again with soap and water to remove any residual medication.
Maximizing Safety and Managing Side Effects
Nitroglycerin ointment can cause side effects due to systemic absorption. Being prepared for these is an important part of treatment.
Common Side Effects
- Headache: This is the most common side effect and is a sign that the medication is working by widening blood vessels. Headaches often decrease in severity over time. Your doctor may suggest a pain reliever like acetaminophen to help manage it.
- Dizziness and Lightheadedness: This can occur due to a drop in blood pressure. To minimize the risk, rise slowly from a sitting or lying position.
- Flushing: A reddening of the skin can be a minor side effect.
Important Safety Precautions
- Avoid Alcohol: Consuming alcohol with nitroglycerin can further lower your blood pressure and increase the risk of dizziness.
- Do Not Use with PDE5 Inhibitors: This is a critical warning. Do not use nitroglycerin if you are taking medications for erectile dysfunction, such as sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis). The combination can cause a dangerous drop in blood pressure.
- Store Correctly: Keep the tube tightly closed and store it at room temperature, away from excess heat and moisture. Dispose of any unused ointment 8 weeks after opening the tube.
Nitroglycerin Ointment vs. Alternative Treatments
If nitroglycerin is not effective or its side effects are intolerable, other treatments are available.
| Feature | Nitroglycerin Ointment (e.g., Rectiv) | Topical Calcium Channel Blockers (e.g., Diltiazem) |
|---|---|---|
| Mechanism | Relaxes anal sphincter by improving blood flow via vasodilation. | Relaxes the anal sphincter muscle directly. |
| Common Side Effect | Headache (can be severe) is very common. | Significantly lower incidence of headaches. |
| Efficacy | Healing rates vary; some studies show around 60% efficacy vs. placebo. | Reported healing rates are comparable or potentially better than nitroglycerin. |
| Headache Incidence | High (around 56% in one review). | Low (around 7% in one review). |
| When to Use | Often considered a first-line medical therapy. | An alternative if nitroglycerin is ineffective or causes severe headaches. |
Duration of Treatment and What to Expect
Treatment with nitroglycerin ointment typically involves application as prescribed by your doctor. It's important to use it consistently for the prescribed duration. If your pain does not improve, or if your symptoms worsen, you should contact your doctor. In some cases, patients may develop a tolerance to the medication over time, reducing its effectiveness. Your doctor can discuss alternative treatment paths if this occurs.
Conclusion
For many patients, nitroglycerin ointment provides an effective non-surgical solution for the pain of anal fissures. Following the proper application technique, measuring the dose accurately as directed by your healthcare provider, and adhering to safety precautions are all crucial steps for successful treatment. Managing side effects like headaches by following your doctor's advice is also a key part of the process. By understanding the correct procedure and potential side effects, you can maximize your chances of healing and find relief from this painful condition. Always consult your healthcare provider with any questions or concerns during treatment.
