I’ve just been back to see my GP to get the prescription for the Anoheal (diltiazem). He said further to my call yesterday, the pharmacy had been trying to get hold of some and couldn’t get any locally so they had to do a special order direct from the suppliers which could take a while to be delivered. He said they don’t normally prescribe this because it is more expensive than GTN (nitro) but are willing to in my case because of my small children etc etc. Has anyone else been told it is more expensive? how does the diltiazem work in comparison to the GTN?

A:
Diltiazem is a calcium channel blocker, Nitro is a vasodilator. I would call around and compare prices- availability and not rely on the doctor or pharmacy especially if you need it now.

I had LIS in october and my fissure finally healed but the area still can be tender at times.
I tried the diltiazem and I find it burns and irritates the most. I’ve used nirto and nifedipine and I think the nifedipine is the least irritating and works the best but that’s just my opinion.
I had other issues besides the fissure, scar tissue from an old hemorrhoid surgery and ibs and some pelvic floor problems so I think the area where the fissure was and some of the old skin tags stay tender for quite a while. The only thing that seems to help me when things do get tender are sitz baths. Of course eating more fiber and keeping bms strain free are a must. If the diltiazem is irritating you tell your doctor and see if you can try something else.
If you have a health food store close by try pure aloe vera, you have to store it in the fridge but that’s even better. It feels cool and soothes the irritated skin.

Benefiber/Metamucil thickening digestive tract?

I spoke with a nutritionist and he mentioned that taking psyllium products consistently such as Benefiber/Metamucil can cause your digestive tract to thicken. He said the best way to avoid this problem is to take psyllium every other 2 week.
I googled to verify this information but got no results.
Anyone have any idea?

Metamucil

A:

The difference between Benefiber & Metamucil

Fiber acts kind of like a colon cleanser. It moves the food you eat through your digestive tract quicker and the bulk of it is what pushes against the wall of the colon on it’s way out to clean it out. It doesn’t thicken anything but your stool. I don’t understand what your nutritionist means by thickens your digestive tract. The main ingredient there is wheat dextrin.
I think Metamucil is more of a bulking fiber than Benefiber. Too much bulking up of your stool like you get with metamucil isn’t really helpful to a person that suffers from anal fissures because your back side has to stretch too much to pass it, that’s why a lot of us like Benefiber. When you have fissures you need a consistently soft, strain free stool so if you only took it every 2nd week how would that help you in the first week.

I am a HUGE proponent of Benefiber as it really softens things better than any other product I’ve tried. This (on top of Miralax & lots of water) was the only thing that finally helped me heal my fissure after 7 months of debilitating pain & after trying so many different things including botox, LIS, aloe vera, wheatgrass cream, Metamucil, Nifedipine, Nitroglcerin ointment, etc.

I literally felt the tear (glass-passing sensation) every single BM (even 3 months after LIS) until I added Benefiber to my regiment.

How I use Benefiber & Miralax

I take 3 Tablespoons of Benefiber throughout the day & Miralax at night. I make sure to drink 64 oz of water a day. When I get to work, I put 2 Tablespoons of Benefiber into 32 oz of water & sip on it all day. Then, with dinner I have 1 Tablespoon of Benefiber with 16 oz of water. Then, before bed, I take a quarter dose (17 gms is regular dose) of Miralax with 16 more oz of water. I was taking 1-1.5 x a full dose plus the 3 Tablespoons of Benefiber when my fissure was at it’s worst & finally began to heal.
I’ve found it’s easier to use a 32 oz water bottle to make sure I get the 64 oz of water & stick to my schedule.
I can pretty much eat what I want, but I do tend to have a spinach salad & fruit everyday. I usually add peas or chickpeas to my salad for a little more fiber but not always. I think I have a more constipated system than most so don’t know if others would need both Benefiber & Miralax.

At any rate, I wanted to relay my story again & what worked in hopes that it may help someone else. I cannot stress enough about stool consistency! I did not get this & no one stressed to me. I thought things were soft enough for the longest time as it was so much easier to go than what I was used to before the fissure. However, things were not nearly soft enough . . .
need to be the consistency of pudding/soft-serve ice cream in order to heal those suckers! I do recommend shortly after you’ve healed (maybe month) firming things back up though b/c I did experience burning for a while after healing & none of the docs nor I could figure out why since fissure was healed. I am a lifer on the Benefiber & maybe Miralax too

If you have a fissure, just get these products here: Benefiber - Miralax - Metamucil

I have been suffering with chronic anal fissure for about 3-4 years. My story reads like many: a nasty bout of constipation is the likely start; was misdiagnosed by GP for hemorrhoids. I cant even remember all the prescriptions we tried over time, but i do remember they never worked. Finally the pain was so bad I went to a gastroenterologist and he diagnosed a fissure. He gave me diltiazem and 8 weeks later i was fine. For 10 months i thought it was a thing of the past. I was grateful everyday that the pain was gone. Then, out of nowhere, it came back with a vengeance. Eight more weeks of diltiazem and i was in the clear again, but it lasted only a month. So now this thing has completely dominated my life for the last 6 months. Over this period i managed to function by willing my BMs from their normal AM time to PM. (not easy) For me, just walking after the BM brought on intense debilitating spasms, making daily function impossible. So, by having the BM at night, i could soak in the tub, then go to bed, not aggravating it. This was really an amazing breakthrough for me and allowed me to have a semi-normal life. (I hope someone else may benefit
from this seemingly simple adjustment.) All this time i was on diltiazem and analpram, waiting for it to work again. But after so many weeks it became apparent that it wasnt going to work. I was switched to Nifedipine and for the first 4 days it appeared to be working. Then it was all down hill. Its hard to believe the pain could get worse, but it did. WOW! Now i have such intense spasms that i am up all night. I was given lidocaine for the pain, but it does nothing, in fact it seems to aggravate the situation. My MD said he didnt want to give me narcotic painkillers because they would constipate me. So, i have found in my years of dealing with this pain that only two things have brought me quick relief. The first, of course, is the sitz bath. Even this doesnt always help me. The second i have never seen anyone talk  about. I am (or was-not these days!) a yoga practioner and i found that shoulderstand drains the blood out of the lower regions and reduces the overall blood pressure in the area. So, when i am having a wave of spasms i lay down and get my legs up on the wall, the more inverted the better, and the majority of the time, i feel the pressure and the edge of the pain drain away. (Hope this helps someone else too!) I hold it for several minutes, as long as i can and then carry on. This has been my #1 source of relief, as silly as it seems, it really works. But, not all the time. Not recently. I am now so miserable i am forced to consider that which i never wanted to do: surgery. I havent slept in days, cant work, cant do much of anything- i am at my wits end and i need a solution.
So, i finally get to my point: what would you, fellow sufferers do in my position? Botox? LIS?

A:
These remedies are merely band-aids on something that will not go away. Unless you have a medical condition that will not allow you to have the surgery – go for it. You won’t be sorry. The horror stories that you will here – don’t believe it. Find a good CRS and have the surgery. I suffered for years and was scared to death to have the surgery and when the pain and bleeding became too much, I cried “uncle” and had the surgery (three years ago), and I have not had one problem since.
I have had two botox shots in the past year and they seem to have helped. I thought after the first botox all was healed (still using baths and nifedipine) but then developed an odd mass that also made the fissure retear so i did another botox with removal of the mass. Still healing from that using same diet and bath regiment.
Seems to be coming along but one thing i’ve learned over the years – healing is an extremely slow process – give yourself years before you can say you are in the clear and in all likelihood – i’ll have to be vigilant about diet the rest
of my life -but the fissure can be healed or at least reduced to nothing more than an occasional nuisance.

a reply received:

I understand your frustration- I saw 3 different gastro Drs for my Crohn’s and terrible anal pain. The first one told me i was wiping too hard and said to use baby wipes. The second one kept giving me suppositories- which just aggravated things trying to insert them. The third one listened to me, then examined me and said I had a fissure and referred me to a CRS.
See if the next Dr will give you nifedipine- most of us here seem to feel it works better then the nirto or diltiazem, another cream often prescribed. Actually, my 1st CRS refused to give me a script for it- she said she only gives nitro , Botox or surgery. She also told me because I have Crohn’s, she didn’t feel I was a good candidate for surgery but told me I’d eventually get soo bad I’d beg her for it. I didn’t like that attitude, so I asked to have a 2nd opinion from her higher up, and have been with him ever since. Actually, my gastro DR gave the script for the nifedipine when the 1st CRS refused to give it – bless him! The 2nd CRS now refills it. Hope you can find some relief!