An anal fissure is a tear in the lining of the anus and typically extends into a circular ring of muscle called the anal sphincter. These tears can typically cause a sharp pain that starts with the passage of stool. The pain can last anywhere from several minutes to several hours. Unfortunately, those who struggle with anal fissures will try to avoid bowel movements to prevent the pain. But, did you know that this condition can be treated using 3 different heart medications, Diltiazem, Nifedipine or Nitroglycerin? 

Nifedipine with Lidocaine ointment is manufactured in other countries, but in the US, it must be compounded. Nitroglycerin is also available as an ointment, but the manufactured dose is too high. In this case, a lower effective dose must be compounded. Either of these ointments are great nonsurgical treatment options that typically are applied twice daily for a period of about 4-6 weeks. After consulting with your physician, they may decide to prescribe you this medication. 

But how can heart medicine help someone with anal fissures? These medications work by reducing the internal anal sphincter, thereby relaxing the muscle and promoting blood flow to the area, resulting in quicker healing. Topical treatment with Diltiazem 2% or Nifedipine 0.2%-0.3% 2- 3 times daily for 4-6 weeks has been effective with zero to few mild side effects. Nitroglycerin, on the other hand, can present with severe headaches and a decrease in blood pressure. Something that we always advise patients to look out for when taking this medication. 

In addition to the compounded ointments, a combination of supportive measures including laxatives, high fiber diets, sitz baths and topical analgesics will also help with the healing and pain associated with anal fissures

Stephanie Haire ~ Pharm D

https://pubmed.ncbi.nlm.nih.gov/33532409/

https://www.uptodate.com/contents/anal-fissure-medical-management

https://journals.lww.com/ajg/Fulltext/2004/10001/TREATMENT_OF_ANAL_FISSURE_WITH.341.aspx

https://www.mayoclinic.org/drugs-supplements/nitroglycerin-rectal-route/proper-use/drg-20075252

The content provided on this blog is for informational purposes only and should not be considered medical advice. Always consult with your physician regarding any questions or concerns you may have about your health.