At a glance
Nifedipine cream is prescribed to relax the internal sphincter muscle, which can let more blood reach a fissure so it has a better chance to heal. Our overview of nifedipine cream covers how it works. This page is about the day-to-day questions.
People using it ask the same handful of things again and again:
- Where exactly does it go?
- Before or after a bowel movement?
- Is the burning normal?
- How long do I keep going?
- Why does it still hurt if the doctor says it has healed?
The honest answer to several of these is that instructions vary between prescribers. That is not a sign anyone is doing it wrong. It does mean it is worth asking your own clinician for clear, specific instructions, and writing them down.
This page does not give doses or schedules. Follow the label on your prescription and the advice of the person who prescribed it.
Where it goes: outside, just inside, or on the fissure
This is the most common point of confusion in people’s accounts, and the reason is simple. Different clinicians say different things.
People describe being told:
- On the skin around the opening. Some prescribers say this is enough because the medicine is absorbed and reaches the muscle.
- Just inside the opening. Others ask for a small amount just inside, where the sphincter sits.
- Directly on the fissure. Some say to aim for the tear itself.
A recurring story is someone getting two different answers from two clinicians in the same month. Another is a printed label saying “external use only” while the doctor said otherwise. Both leave people unsure.
What people find helpful:
- Asking the prescriber to point out or describe the spot, not just say “apply it”.
- Asking the pharmacist to confirm what the label means for this cream.
- Not forcing anything. If reaching where you have been told is very painful, say so. Your prescriber can suggest another approach.
Some people notice that applying higher up seems to give them more side effects, like headaches, than applying to the outside. That is another reason to check what your prescriber intends rather than experimenting. Our guide to applying rectal ointment covers hygiene, gloves and finger cots in more detail.
Timing around bowel movements
People report three patterns:
- After a bowel movement. The logic is that the cream will not be wiped away straight after it goes on. Many people clean gently, pat dry, then apply.
- Some time before. Some are told an earlier dose may help the muscle relax ahead of a bowel movement.
- A mix. Some use regular set times and do not link doses to bowel movements at all.
There is no single right answer in people’s accounts. What tends to matter more is consistency. Missed doses are common in the first weeks, and people often say phone reminders helped.
If a bowel movement happens soon after a dose, ask your pharmacist what they suggest. Do not double up unless you have been told to.
The burning on application
A short sting when cream touches broken skin is common. People often describe it as worse in the first few days and easier after that.
Other sensations people mention:
- A cold or cooling feeling with some bases, and a warming feeling with others.
- A sense of pressure or fullness for a while after applying.
- Mild throbbing, which some link to the muscle relaxing.
Things that are worth a call to your prescriber or pharmacist:
- Burning that gets stronger over days instead of settling.
- Itching, redness or a rash spreading beyond where the cream goes.
- Swelling, blistering or weeping skin.
Reactions can come from the nifedipine itself, from lidocaine if your cream contains it, or from the base it is mixed into. A few people only react after weeks of use. If the cream has been made up by a pharmacy, it can sometimes be remade without one ingredient.
Headaches, flushing and light-headedness are also reported, though usually less than with GTN. Chest pain, a racing heart or fainting needs urgent attention, not a wait-and-see.
How long people keep using it
Accounts vary widely. Common patterns:
- A first course of around six to eight weeks, then a review.
- Some told to keep going for several more weeks after pain settles, because newly healed skin is thin and easily torn.
- A few who use it for many months, with their clinician’s agreement.
- Some who stop after a week or two because they felt no change. Many later wondered if that was too soon.
People describe the healing as uneven. Good weeks are followed by a setback, often after one hard or large stool. A setback does not mean starting from zero, though it can feel that way.
Before stopping, people commonly ask their prescriber:
- Should I stop all at once or reduce gradually?
- What would make you want me to restart?
- How long should I keep going after the pain goes?
See how long to use topical treatment and when to stop treatment after a fissure heals for more.
Healed but still sore
A clinician says the fissure has closed. It still hurts. This is one of the most frustrating places people describe, and it is more common than many expect.
Explanations people are given include:
- Muscle spasm or a tight pelvic floor that carries on after the tear has closed.
- Irritated or sensitised skin, sometimes from weeks of creams, wiping and washing.
- A reaction to the cream itself, which can feel a lot like fissure pain.
- A second small tear that is hard to see without a closer look.
- Fragile new skin that stings with each stretch for a while.
Some people find the soreness fades over weeks. Others are referred on, for example to pelvic floor physiotherapy. Keeping a short daily note of stools, pain and timing helps clinicians see the pattern. Our guide to pain after a fissure has healed goes into this further.
When to seek care
Get urgent help (go to A&E or an emergency department, or call 999 in the UK or 911 in the US) if you have:
- Heavy bleeding, or bleeding that will not stop
- Fever with pain, swelling or discharge around the anus
- Severe pain that is getting worse rather than better
- Chest pain, a racing or irregular heartbeat, or fainting after applying the cream
See your GP or prescriber soon if:
- A rash, blistering or spreading itch develops
- Burning gets worse over days instead of easing
- There is no improvement after the course you were given
- Pain carries on after you have been told the fissure has healed
- You are unsure where or when to apply the cream
- Bleeding that is dark, mixed into the stool, or happens without pain
- A change in bowel habit lasting more than a few weeks, or narrower stools
- Unexplained weight loss, or a lump