At a glance
Rectogesic is a brand name for GTN (glyceryl trinitrate) ointment, commonly prescribed for anal fissures and sometimes for other conditions involving sphincter spasm. For many people it provides real relief. But a consistent pattern in community discussions is people asking: is this treatment actually making my pain worse?
This guide covers what people commonly describe when Rectogesic seems to increase pain, possible reasons why, and when it makes sense to go back to your prescriber.
What people describe
The reports tend to follow a recognisable pattern:
- Immediate burning or stinging when the ointment is applied — this is the most common complaint
- A throbbing sensation that develops within minutes of application and can last 20 to 30 minutes
- Headaches — a well-known side effect of GTN that can range from mild to severe
- A feeling that the overall pain baseline has increased since starting the treatment
- Difficulty distinguishing between the condition pain and the treatment pain
Some people describe the burning as brief and tolerable — a few minutes of discomfort followed by noticeable relief. For others, the treatment pain is as bad as or worse than the fissure or spasm pain itself.
Why it might happen
There are several possible explanations for increased pain with Rectogesic:
The ointment on broken tissue
GTN ointment applied to an active fissure is being placed on an open wound. Some degree of stinging is expected. People with deeper or more inflamed fissures tend to describe more discomfort.
Increased blood flow
GTN works by increasing blood flow to the area. This vasodilation can cause a throbbing, pulsing sensation that some people experience as pain rather than relief.
Application technique
Applying too much ointment, or applying it directly inside the anal canal rather than to the perianal skin, can increase side effects. Your prescriber can advise on the correct technique and amount.
Individual sensitivity
Some people are simply more sensitive to GTN. This is not a failure on your part — it is a physiological variation.
What people try
People who experience increased pain with Rectogesic commonly describe trying:
- Using a smaller amount — sometimes less ointment produces the same therapeutic effect with fewer side effects
- Changing the timing — some people find applying after a sitz bath (when tissue is warm and relaxed) reduces the stinging
- Applying to the perianal skin only rather than inserting the ointment
- Taking paracetamol beforehand to manage the headache and application pain
- Switching to diltiazem — this is a conversation with your doctor, but diltiazem is commonly prescribed as an alternative for people who cannot tolerate GTN
When to talk to your prescriber
Mild stinging on application that fades within a few minutes is commonly reported and usually settles over the first week or two. But certain patterns suggest the treatment is not right for you:
- The application pain is severe and not improving with time
- The headaches are debilitating
- Your overall pain level has increased since starting the treatment
- You are avoiding applying the ointment because of the pain it causes — which means you are not getting the therapeutic benefit
Your prescriber has alternatives available. This is not a situation where you need to push through.
The broader picture
It is worth noting that increased pain during treatment does not necessarily mean the underlying condition is getting worse. Sometimes a treatment causes side effects that feel like worsening, while the fissure or spasm is actually responding. This is why clinician input matters — they can examine the area and tell you whether the condition itself is changing, separate from how the treatment feels.
If you are unsure whether what you are experiencing is a normal side effect or a sign that something else is going on, that is a good reason to make contact with your prescriber.