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The average age of the children in this study was about 3 years. The study suggested that diltiazem ointment was better than gtn at healing anal fissures in children (23 out of 28 using diltiazem were healed compared with 11 out of 28 using gtn). The goal of treatment is to relieve pain and discomfort, and heal the torn lining. Acute anal fissures -- the ones that dont last longer than 6 weeks -- are common and usually heal on their own. An anal fissure is a tear in the skin of the lower half of the anal canal (back passage). Symptoms can include severe and sharp pain, irritation and tenderness. Certain fissures may heal quite quickly, whereas others can take several months to heal. Diltiazem hydrochloride works by relaxing the muscle around the anus (the anal sphincter). diltiazem and lidocaine are important medications in the treatment of anal fissures. Diltiazem relaxes the anal sphincter to aid in the healing process. Doctors avoid prescribing narcotic pain medications for anal fissures because narcotics can cause constipation, which could worsen anal fissures. Topical diltiazem ointment in the treatment of chronic anal fissure. Author information (1)department of colorectal surgery, royal berkshire and battle hospitals, oxford road, reading rg30 1ag, uk. Eu you can find more information about anal fissures and order a diltiazem cream that will be compounded specifically for you. Our goal is to offer accurate information and a product that should be available to everyone, but isnt. Anal fissures represent one of the most common anorectal conditions encountered in medical practice. Chronic anal fissures (present for 6 weeks or longer), and associated pain, may be treated with glyceryl trinitrate rectal ointment 0. 2 unlicensed (available from special-order manufacturers or specialist importing companies). Limited evidence suggests that the strength used does not influence the effectiveness, but that the higher strength potentially. In approximately 90 of patients the anal fissure is located in the posterior midline. It is hypothesised that this predilection for the posterior midline may occur because this portion of the anal canal is poorly perfused. 7, 8 anterior anal fissures affect approximately 10 of patients and may have a different pathophysiology. They are associated with younger, mostly female, patients often. Topical calcium channel blockers are also commonly used to manage anal fissures, although this is an unapproved use. 1 if the use of topical nitrates has not improved symptoms or where the adverse effects of nitrates are intolerable, topical diltiazem 2 (requires pharmacy preparation), two to three times daily, may be used.