What this experience covers
This experience describes the daily reality of using prescribed topical treatments for an anal fissure — glyceryl trinitrate (GTN, also known as nitroglycerin or by the brand name Rectogesic), diltiazem, and nifedipine. It covers the routines people build, the side effects they manage, the uncertainty of whether it is working, and the practical knowledge that only comes from living with these treatments day after day.
This is drawn from over 320 anonymized forum accounts. No single person’s story is told here.
The pattern
The first application: nobody prepares you for this
People consistently describe the first time applying the medication as unexpectedly difficult. The instructions say to apply a small amount internally, but what counts as a small amount? How far inside? Which finger? People describe feeling uncertain and slightly ridiculous — and then, depending on the medication, feeling the side effects hit.
For GTN users, the headache can arrive within minutes. People describe it ranging from a dull throb to what many call god awful headaches that make it hard to function. For diltiazem users, a localised burning or itching is common — what some people refer to as the diltiazem itch. Nifedipine tends to sit between the two in terms of side effects.
Building a routine: twice a day, every day
The treatment requires consistency — typically two to three applications daily for eight to twelve weeks. People describe building their day around it. Morning application before work. Evening application before bed. Washing hands, finding privacy, managing the mess. It becomes a routine, but not one anyone talks about.
The side effects: headaches, burning, and everything else
Side effects are the dominant theme across accounts. GTN headaches are so common that many people switch medications because of them. The headaches and dizziness can be severe enough to affect work and driving. Some people find that starting with a smaller amount and building up helps. Others never adjust.
Diltiazem side effects tend to be more localised — burning intensely on application, itching that persists, and for some people, swelling. People describe everything down there feeling really puffy, particularly in the first weeks.
The uncertainty: is it working?
This is the question that dominates the experience. Weeks pass. The pain might be slightly less, or it might not. People describe feeling very defeated when they cannot tell whether the treatment is making a difference. The healing is supposed to be gradual, but gradual can feel indistinguishable from nothing.
When it works vs when it does not
Some people reach a turning point — usually around weeks four to six — where they notice the pain after bowel movements is shorter, or the sharp edge has softened. Others reach the end of their prescribed course with little improvement and face the conversation about next steps.
What ties it together
The topical treatment phase is a test of patience and consistency. People who get through it — whether successfully or not — consistently say the same thing: they wish someone had been honest with them about what it would actually be like. This experience aims to be that honest account.