Back on 3/28 I had a case of what I thought was hemmorrhoids get excruciating. There was some blood , pain like passing a wad of baarbed wire with a BM for several days before that. On that particular day several hours after the painful BM I began having severe pain that felt like someone was pushing a lit cigar up my anus and it lasted for hours. Thinking it was Hemmorrhoids I tried to remedy it on my own for a week. By April 2, I had figured I had an anal fissure. On Thur. 4/5 I went to see my GP who got me in that same day to see a gastroenterologist. HE did a digital exam of my anus (extreme pain) and confirmed my belief of an anal fissure. He prescribed hydrocortizone2.5 , anusolHc and low level hydrocodone. He directed me to take 2 to 3 sitz baths a day. The pain did not get better at all perhaps even worse. By 4/12 I was in such agony I called the gastro doc back and said we had to do something because I could not work with this pain. He got me scheduled to see a colorectal surgeon on 4/13.
The surgeon likewise did an exam but he did not insert his finger in my anus (Thank God) he spread my cheeks and said yes I see an anal fissure. I told Him I wass ready for surgery if that is what he thought he needed to do to get me relief from this pain. He said he wants to try to treat it medically first. So, he prescribed diltiazem 2%, twice aday on the anal verge, valium everyeight hours for spasm as needed (but only gave me 20) and ultram 1or 2 every six hours for Pain(only gave me 40) He said take miralax every day lots of fiber and try to keep my stool fluffy without form.

I have done all that except my stool has been soft and in many separate pieces 75 to 80 perecent of the time, soft fluffy and without form 10% and loose 5%or so.
I have had no blood now for over a week. The pain at the time of the BM has reduced considerably, but the spasm pain is sometimes just as bad or worse thaan before I saw the surgeon. Sometimes not.

For instance Fri. eve I had salmon vegetables and Iced tea for dinner and felt fine. I had had a BM that AM and after a sitz bath the day went by with very little spasming. When I got home Fri. night about 11pm I had a bm and about 30 minutes later it started spasming and was excruciating until somewhaere between 2:30 and 3 am when I finally fell asleep. now by 11:45 I had taken a valium and a pain pill. The Pain was sooo bad I was in and out of the bath tub 2 or 3 times, walked up and down the drive once, and rolled around in the floor for a bit none of it seemed to help except the baths. As I said though it finally eased up after 2am and I slept until 8:30 to 9 am on Sat. I arose ate raisin bran and dreaded th forthcomeing BM. It was not very painful only at the end when the sphinter closed everthing off and spasmed a bit did it hurt but that was pretty bad. I climbed into the tub and soaked for about 15 minutes. Showered got out and did okay all day , to the point that we went to a friends for a cookout for the late afternoon and evening. NO PAIN,
ate a bowl of beans(kidney and navyseasoned with some ham, a pice of fried fish, and a small piece of broiled chicken and a piece of cake. I drank a lot of water. Got home about 11pm . Had to take a BM it seemed soft but in many pieces. It did not hurt much until the end when the sphincter closed off and I hopped in the tub for about 25 minutes. By midnight it was hurting a lot and continued to hurt a LOT until somewhere between 4am and 5am. When I awoke at 10 AM I felt relatively fine , my butt did not hurt at all. Had a cup of coffee, when I had a BM after the coffee the BM did not hurt and the closing off of the sphincter did not hurt as much as it had been , in fact it did not hurt too bad at all. The stool was soft fluffy and without form . I hopped in the tub for about 10 minutes, then showered and the day has thus far been Okay. A little achy and a little pain here and there but pretty much okay.

My question is : How soon should the diltiazem cause the spasms to stop?

Can the diltiazem be working and the spasms still occur after a BM ?

How Long should I deep experiencing this pain evern with the diltiazem and the valium before I determine that it is not going to work and I need to go ahead and have surgery?
In a nut shell How do I tell if I am getting better?

Thanks for any advice that you may be able to give me!

i have use diltiazem for my fissure ,what is does is relax your rectal
pressure tone so your fissure can heal.you need to understand that
it could take up to two weeks or longer to work. i had some success
with it but my fissure was so bad ,it would not heal.spasm wil occur
at the beginning but if its does not stop ,you need to have surgery.
because this is the only way to relax your tone for your fissure to heal.
if your in pain for more than a month and your life revolves around it
do the surgery.
i had hemorrhoid and fissure surgery all at once and fissure surgery is
instant relief,hemroid surgery is painful recovery.
make sure you find a colorectal surgen to do this ,there no room for error!
start colace its a stool softer,bran or fiber drink and lots of water,you want
one soft tube stool every day .no pushing and gat off the toilet after bm,
if your bleeding stop the stiz baths,it causes more

good luck

I am applying the diltiazem 2x a day for 12 days now. The bm has been w/out blood for 12 days. The bm has been down to mild discomfort to no pain now since Sun. the ninth day. However, the spasm has occurred and felt like someone putting a lit cigar up my behind Mon. Tues. and today ranging in time from1/2 hour to a couple of hours and seems to come on two to three hours after the bm.
Sitz bath or soaking in the tub gives relief. By evening I feel pretty pain Free.

Is this normal? Does it sound as though it is healing in a normal fashion?
I ask because when it is "spasming" it is still EXCRUCIATING. But then it passes and I feel relatively Fine.

Thanks for your help!!