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Patient instructions

Anal Fissure Ointment Patient Instructions

These instructions are for compounded nifedipine, diltiazem, or nitroglycerin ointment prescribed for anal fissures — a small tear in the skin lining the anus. The ointment relaxes the internal anal sphincter, which reduces pain, and improves blood flow to the tear so it can heal. About 1 in 5 people develop a fissure in their lifetime, and roughly 80 to 90 percent heal with topical treatment. Available by prescription only.

Pea-sized, just outside

A small pea-sized amount applied just outside the anal canal is enough. More is not better — it only increases absorption and side effects.

Around bowel movements

Apply before and after each bowel movement, in addition to your regular 2 to 3 times a day.

Fibre, water, sitz baths

The ointment works best alongside the first-line bowel regimen — softer stools mean less re-tearing while the fissure heals.

How to Use

  1. 1Wash your hands before applying. You may want to wear a glove or finger cot.
  2. 2Apply a small pea-sized amount with your finger just outside the anal canal — preferably not directly onto the fissure, which can be uncomfortable.
  3. 3Apply 2 to 3 times a day, or follow the directions on your prescription label.
  4. 4Also apply before and after each bowel movement.
  5. 5Wash your hands again after applying — the medication can irritate your eyes.
  6. 6Keep going for the entire treatment period. Fissures take several weeks to heal, and stopping early is the most common reason treatment fails.

The Bowel Regimen

First-line management of a fissure is keeping stools soft so each bowel movement does not re-tear the skin:

  • A stool softener, if your prescriber or pharmacist recommends one.
  • 25 to 35 grams of fibre daily.
  • Plenty of water through the day.
  • Sitz baths (sitting in a few inches of warm water) for comfort.

If You Miss a Dose

  • Apply the missed dose as soon as you remember, unless it is nearly time for the next one — then skip it.
  • If you are unsure what to do, contact the pharmacist.

Side Effects

Side effects are very uncommon. When they occur, it is usually early in treatment, while the damaged skin lets more medication be absorbed. You may notice:

  • Perianal itching or soreness.
  • Headache.
  • Light-headedness.
  • Flushing.

Report These Right Away

Contact your prescriber or health care professional as soon as possible if you notice:

  • Agitation, nervousness, or confusion
  • Fast or irregular heart rate
  • Vision changes
  • Swollen or tender gums
  • Dizziness, weakness, or fainting

A very serious allergic reaction is rare. Seek immediate medical attention for rash, itching or swelling (especially of the face, tongue, or throat), severe dizziness, or trouble breathing.

Storage

Store at room temperature, away from extremes of heat or moisture, and out of reach of children. Check the beyond-use date on the pharmacy label — compounded ointments have shorter dating than commercial products.

When to Call the Pharmacy

  • The ointment causes local irritation — stop using it and call.
  • You are pregnant or think you may be — check with your physician or pharmacist before using.
  • Pain is not improving after a few weeks of consistent use — stronger mixtures, or a rectal rocket that holds the medication in contact longer, may be options to discuss.
  • You are running low — compounded ointments are prepared to order, so plan refills a few days ahead.