At a glance
Rectogesic is a brand name for GTN (glyceryl trinitrate) ointment used to treat anal fissures. It works by relaxing the internal sphincter muscle, reducing pressure, and improving blood flow to support healing. The application process is one of the most discussed practical challenges of using this treatment.
This guide addresses the common difficulties people describe and provides practical strategies for making the process more manageable.
Why application is difficult
People describe several challenges with applying Rectogesic:
Pain on application
The ointment is being applied to or near an open wound in one of the most sensitive areas of the body. Some stinging or discomfort during application is normal. It typically settles within a few minutes.
Awkward positioning
The anatomy makes self-application physically awkward. People describe difficulty reaching the area comfortably, particularly when they are already in pain from the fissure.
Headaches
Rectogesic (GTN) commonly causes headaches. This side effect can start within minutes of application and can be significant. The anticipation of the headache adds a psychological barrier to applying the ointment.
Emotional reluctance
After weeks of pain, the last thing people want to do is touch the area that hurts. The emotional resistance to application is real and valid.
Making it easier
Timing
After a sitz bath: Application after a warm sitz bath is the most commonly recommended approach. The warm water relaxes the sphincter, increases blood flow, and makes the area less sensitive. Many people describe significantly less pain when applying after a bath compared to applying to cold, tense tissue.
After a bowel movement: The area has already been stimulated, and the sphincter may be more relaxed. Follow a sitz bath with application for the best combination.
Before bed: Some people prefer to apply at bedtime so they can sleep through the worst of the headache. This also means the ointment is in place for a sustained period overnight.
Technique
- Use a small amount — a pea-sized portion is typical
- Apply gently — do not push deeply into the anal canal
- Lie on your side — many people find this position easiest for reaching the area
- Use a glove or finger cot — provides a smoother surface and can make application feel more manageable
- Warm the ointment between your fingers first — cold ointment on tender tissue stings more
- Be systematic — apply in a circular motion around the anal canal opening and just inside
Managing the pain of application
- Take paracetamol 30 minutes before application if the pain is significant
- Breathe steadily during application — holding your breath increases tension
- Remind yourself it is brief — the stinging typically lasts one to three minutes
- Follow immediately with rest — lie still for a few minutes after applying
Managing headaches
The headaches from Rectogesic are the most common reason people struggle with compliance:
- Paracetamol before application may help
- Start with a smaller amount and build up as your body adjusts
- Apply at bedtime to sleep through the worst
- Stay hydrated — dehydration can worsen headaches
- Give it time — some people find the headaches lessen over the first week or two
Common mistakes
- Applying too much — increases side effects without improving effectiveness
- Skipping doses because of headaches — inconsistency reduces the treatment’s chance of working
- Applying to cold, tense tissue — always warm the area first with a sitz bath
- Rushing the application — taking a moment to be gentle and deliberate reduces discomfort
- Giving up too early — the first few applications are usually the worst; it often becomes easier
When to talk to your clinician
- If the headaches are severe and not improving after the first week
- If the pain of application is making it impossible to comply with the treatment
- If you notice a skin reaction at the application site
- If you are unsure whether you are applying correctly
- If symptoms are not improving despite consistent use
When to seek care
Contact your clinician if:
- Heavy or persistent bleeding
- Pain that is significantly worsening
- Fever or signs of infection
- Side effects that are intolerable