Skip to content
Beverly Hills · 435 N. Bedford Dr., Suite 308Mon–Fri 9:00 am – 5:00 pmMost PPO insurance accepted
Allen KamravaMD · MBA · FACS · FASCRS

Medication

Topical Nitroglycerin / Calcium Channel Blockers

A prescription ointment you use at home that relaxes the sphincter muscle so the fissure can finally heal — usually the first treatment we try.

Request a consultation
Back to work
No downtime — you carry on with normal life while it works
Success rate
50-90%
Recurrence
Up to 50%

What it is

What are Topical Nitroglycerin and Calcium Channel Blockers?

Topical Nitroglycerin (NTG) and Calcium Channel Blockers (CCBs) like diltiazem and nifedipine are medications applied directly to the perianal skin to treat chronic anal fissures. These medications work as chemical sphincterotomies by relaxing the hypertonic (overly tight) internal anal sphincter muscle. Nitroglycerin is a nitric oxide donor, which directly relaxes smooth muscle. Calcium channel blockers work by blocking the influx of calcium into smooth muscle cells, preventing their contraction. By reducing the resting pressure of the internal anal sphincter, these medications improve blood flow to the fissure, which promotes healing and reduces pain.

Am I a candidate?

Who are Good Candidates for this Therapy?

This therapy is a first-line treatment for patients with chronic anal fissures who have failed conservative management with dietary fiber and sitz baths. It is an excellent option for patients who wish to avoid the potential, albeit small, risk of permanent incontinence associated with a surgical lateral internal sphincterotomy. These medications are effective for fissures associated with internal sphincter hypertonicity.

How it's done

  1. 1Your prescription is a small tube of ointment — nitroglycerin, or a calcium channel blocker such as diltiazem or nifedipine.
  2. 2A pea-sized amount goes on the skin at the anal opening, usually two to three times a day, as prescribed.
  3. 3It relaxes the internal sphincter muscle underneath, improving blood flow so the fissure can heal.
  4. 4Keep it up for the full prescribed course, even once you feel better — stopping early is a common reason fissures come back.
  5. 5Alongside it: fiber, fluids, and warm sitz baths. Soft stools protect the healing fissure.

What to expect

  1. Right away

    This is an at-home treatment — no procedure, no downtime.

  2. If you're using nitroglycerin

    Headache is the honest downside — it affects at least 30% of people (about 1 in 3) and leads up to 1 in 5 to stop the medicine. Tell us if it happens; switching to a calcium channel blocker ointment usually solves it, and those work about as well.

  3. First weeks

    Pain gradually eases as the muscle relaxes and the fissure starts to heal.

  4. Over the course

    About half of chronic fissures (roughly 50%) heal with topical therapy. If yours isn't one of them, that isn't a failure on your part — Botox or a small operation are the reliable next steps.

Risks & considerations

What are the Risks?

The side effects of these topical medications are generally mild and well-tolerated. For Nitroglycerin, the most common side effect is a headache, which can be severe in some patients. Dizziness and lightheadedness can also occur. For Calcium Channel Blockers like diltiazem and nifedipine, side effects are less common but can include localized itching or burning, and rarely, headaches. Systemic side effects are rare because the medication is applied topically and is poorly absorbed into the bloodstream. It is important to apply the ointment to the perianal skin and just inside the anal verge, not deep within the anal canal.

Sources

CallBook