Treating an anal fissure requires relaxation of the internal anal sphincter.
Rectogesic (GTN) is the only over the counter ointment that works to relax the internal sphincter.
Make sure you advise the patients to apply about 2cm of ointment using a gloved index finger into the distal anus as far in as the fissure. It should be applied 2-3 times a day for up to six weeks.
General advice regarding softening their stools is also required.
You can prescribe topical Nifidipine 0.5% + Lignocaine 5% ointment.
This requires a prescription and needs to be made up at a compounding chemist.
Haemorrhoid creams or ointments such as Proctosedyl and Scheriproct usually contain a combination of steroid and local anaesthetic. While they may help with anaelgesia and to reduce inflammation from associated haemorrhoids, they have no effect on the anal sphincter. They are, therefore, not effective in the treatment of anal fissures.
Helicobacter pylori eradication therapy
If a repeat course of Nexium Hp7 fails to eradicate H pylori infection, it is likely to be due to clarithromycin resistance. A levofloxacin-based regimen is advised:
- Prescribe 10 days of Levofloxacin 500mg bd (from a compounding chemist) + Amoxycillin 1g bd + Nexium 40mg bd.