The primary medical use of Diltigesic Gel
Diltigesic Gel is a prescription topical medication primarily used to treat chronic anal fissures. An anal fissure is a small tear in the thin, moist tissue that lines the anus, causing significant pain, especially during and after bowel movements. The active ingredient is diltiazem, a calcium channel blocker. Unlike oral forms used for conditions like high blood pressure, the topical gel is applied directly to the affected area for a localized effect. The gel works by relaxing the internal anal sphincter muscle, which helps reduce pressure on the fissure and increases blood flow, essential for healing.
How Diltigesic Gel works in the body
Diltiazem, as a calcium channel blocker, targets the smooth muscle cells of the anal sphincter. This action leads to muscle relaxation, reducing the high anal resting pressure often associated with fissures. The reduced pressure improves blood circulation to the torn tissue, delivering vital nutrients and oxygen for healing. This process also helps alleviate pain and discomfort. The topical application minimizes systemic absorption, reducing the risk of systemic side effects compared to oral diltiazem.
How to apply Diltigesic Gel
Correct application is crucial for effectiveness and to minimize irritation. While always following your doctor's instructions, typical guidelines include cleaning and drying the anal area, using a finger cot or glove for hygiene, applying a pea-sized amount just inside the anus to the fissure, and following the prescribed frequency, usually two to four times daily. It's important to complete the full course of treatment and maintain good hygiene.
Potential side effects
Diltigesic Gel is generally well-tolerated, but some mild and temporary side effects can occur.
Common side effects:
- Application site reactions (burning, itching, irritation, redness)
- Headache
- Dizziness or light-headedness
- Rectal bleeding (less common but possible)
Serious but rare side effects:
- Severe allergic reactions (rash, swelling, difficulty breathing)
- Severe skin reactions
- Liver problems
Contact your healthcare provider if you experience severe or persistent side effects.
Comparison with other topical treatments for anal fissures
Diltigesic Gel (topical diltiazem) is often compared to topical glyceryl trinitrate (GTN). Both are effective, but studies indicate differences in tolerance and recurrence rates.
| Feature | Diltigesic Gel (Topical Diltiazem) | Glyceryl Trinitrate (GTN) Ointment |
|---|---|---|
| Mechanism | Relaxes anal sphincter by blocking calcium channels. | Relaxes anal sphincter by donating nitric oxide. |
| Healing Rate | Comparable to GTN; studies show high effectiveness. | Comparable to diltiazem; effective in many patients. |
| Side Effects | Significantly fewer side effects. Common side effects include mild local irritation and headache. | Often associated with headaches, which can be severe and limit use. Also causes hypotension. |
| Recurrence | Lower rate of recurrence reported in some studies. | Higher rate of recurrence compared to diltiazem. |
| Patient Comfort | Better tolerated by patients, especially concerning systemic side effects. | Headaches can be a major barrier to compliance. |
Contraindications and precautions
Discuss your medical history with your doctor before using Diltigesic Gel.
Contraindications include:
- Known allergy to diltiazem or other ingredients
- Severe heart problems
- Low blood pressure
Precautions:
- Pregnancy and breastfeeding: Safety is not well established; consult a doctor.
- Driving/Operating machinery: May cause dizziness; exercise caution.
- Drug interactions: Inform your doctor of all medications, especially other calcium channel blockers.
Conclusion
Diltigesic Gel is an effective, non-surgical treatment for anal fissures, working by relaxing the anal sphincter to reduce pain and improve blood flow, promoting healing. Studies show comparable healing rates to other treatments with a more favorable side effect profile, particularly fewer headaches than topical nitrates. It offers a targeted approach for chronic anal fissure relief and may help avoid more invasive procedures. Always consult a doctor to determine if this medication is appropriate and for proper guidance on its use. You can find more information in this study: Efficacy of diltiazem 2% rectal gel in the treatment of chronic anal fissure.
