If you are suffering from the sharp, glass-like pain of an anal fissure, you've probably tried over-the-counter piles creams. And you've probably noticed they don't work.
That is because piles creams are designed to shrink swollen veins, not heal torn skin. Fissures require a completely different type of medication.
Why Fissures Don't Heal
A fissure is a tear in the anal lining. When it tears, the underlying sphincter muscle goes into a tight spasm. This spasm pulls the edges of the tear apart and restricts blood flow to the area. Without blood flow, the tear cannot heal. This becomes a vicious cycle of pain -> spasm -> no healing -> more pain.
The goal of a fissure ointment is to relax the sphincter muscle so blood can flow back and heal the tear.
Top Medical Ointments for Fissures in India
1. Nitroglycerin Ointment (0.2%)
Brand names: Rectogesic, Nitrogesic
How it works: Nitroglycerin releases nitric oxide, which directly relaxes the smooth muscle of the internal anal sphincter. It increases blood flow to the area, promoting healing.
Side effects: It can cause severe headaches in some patients because it dilates blood vessels systemically. To avoid this, use a very small amount (pea-sized) and apply it just inside the anal verge, not deep inside.
2. Diltiazem Ointment (2%)
Brand names: Cremaffin Fresh, Anovate (specific variants), Diltia
How it works: Diltiazem is a calcium channel blocker. It effectively relaxes the sphincter muscle but with far fewer side effects than Nitroglycerin.
Doctor's Verdict: This is currently the first-line treatment prescribed by most proctologists in India. It is highly effective for acute fissures (less than 6 weeks old) and doesn't cause the headaches associated with Nitroglycerin.
3. Lidocaine / Lignocaine Ointment
Brand names: Lox 2% Jelly, Xylocaine
How it works: This is a local anesthetic. It does not heal the fissure; it simply numbs the area.
How to use: Doctors often recommend applying a Lidocaine jelly 10 minutes before passing a stool to numb the sharp pain, and then applying a healing ointment (like Diltiazem) afterward.
Creams to Avoid for Fissures
Avoid any cream that contains heavy steroids (Hydrocortisone) for prolonged periods. Steroids thin the skin, which is the exact opposite of what you want when trying to heal a tear in the skin.
When Ointments Fail
Ointments, combined with a high-fibre diet and sitz baths, heal about 50-60% of acute fissures. However, if your fissure has been present for more than 6-8 weeks (a chronic fissure), it forms scar tissue (a sentinel pile).
At this stage, ointments will no longer work. You will need a 15-minute Laser Sphincterotomy—a highly effective, minor procedure that permanently relaxes the muscle spasm and allows the fissure to heal instantly. Contact SURGISAATHI to learn more about laser treatments for chronic fissures.