Why do I need this ointment?
You have been found to have a fissure. This is a small tear in the ring of the anus (back passage) which can cause pain, bleeding and itching. A fissure is often caused by passing small hard bowel motions. Diarrhoea can also cause fissures, as can tight anal muscle.
How can fissures be treated?
Until recently, the only non-surgical method of treatment was the advance of constipation and the use of anal dilators (stretchers). If this treatment was not successful, an operation was advised. GTN ointment is now available for the treatment of fissures, and is proving to be successful. Previously, it has been and still is used routinely for treating angina (heart pain).
How does it work?
GTN causes a relaxation of one of the muscles. This increases blood supply to the area of the fissure, thereby allowing the fissure to heal.
Where do I get it from?
GTN 0.2% ointment is currently supplied by your chemist. It is called Rectogesic. It should be kept away from children and stored in a cool place, but does not need to be refrigerated. Discard the remaining ointment after the six weeks treatment period.
How do I apply it?
Wear a rubber glove and get a small amount of the ointment on your index finger. Apply it around your anus; do not rub it in. The ointment should not be inserted into the anus, just on the surrounding skin. Remember to wash your hands immediately after applying the ointment because it can be absorbed from your fingers. The ointment should be applied three times during the day and once last thing at night.
What are the side effects?
We know that up to 30% of people who use GTN ointment suffer from headaches. These headaches often pass after 2-3 days if you continue to use the ointment. If you get these headaches, it could be that you are applying too much cream. Reduce the amount of cream but NOT the frequency of application, and remember to wash your hands immediately after you have applied the cream. If the headaches persist, stop using the GTN and obtain medical advice. Occasionally people can develop a skin sensitivity to the cream. If you notice a rash or severed skin irritation around your anus, please seek medical advice.
It is essential that whilst you are using 0.2% GTN ointment you must not take Viagra (Sildenafil), as this could have potentially serious side effects.
What happens if it does not help?
Studies have shown that up to two thirds of patients with fissures will get benefit from GTN. If, however, it doesn’t work, several surgical options are available and these will be discussed with you at your follow-up appointment.