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Offering pain relief (for example simple analgesia, a topical anaesthetic in adults, andor rectal glyceryl trinitrate gtn ointment in adults with primary anal fissure) and advising on measures to reduce pain (such as soaking in a shallow, warm bath). Lidocaine is the most commonly prescribed topical anaesthetic for anal fissures. It comes in the form of either a gel or an ointment, and is usually only used for 1 to 2 weeks because the fissure should start to heal within this time. Chronic anal fissure limited evidence suggests that the strength used does not influence the effectiveness, but that the higher strength potentially increases the incidence of side-effects. Healing rates with topical glyceryl trinitrate are marginally superior to placebo, but the incidence of headache as an adverse effect is quite high (about 20-30 of patients). Topical diltiazem cream versus botulinum toxin a for the treatment of chronic anal fissure a double-blind randomized clinical trial. Lateral sphincterotomy for chronic anal fissure prospective, randomized trial. These may include a medicated cream (to help heal the fissure), a topical muscle relaxant (to relax the anal muscles), an anesthetic ointment (to reduce pain, if pain interferes with having a bowel movement), or nitroglycerin or calcium channel blocker ointments (to relax the anal muscles and increase blood flow to the region, promoting healing). Because topical diltiazem is an unlicensed product nice, 2013b prescription pricing authority, 2016, cks recommends seeking specialist advice regarding the use of topical diltiazem in adults with anal fissure who are unable to use rectal gtn ointment. Topical anaesthetics do not help fissures to heal, but they can help ease the pain. Lidocaine is the most commonly prescribed topical anaesthetic for anal fissures. It comes in the form of either a gel or an ointment, and is usually only used for one to two weeks because the fissure should start to heal within this time. lidocaine 3 cream is a topical anesthetic indicated for the relief of pruritus, pruritic eczemas, abrasions, minor burns, insect bites, pain, soreness, and discomfort due to pruritus ani, pruritus vulvae, hemorrhoids, anal fissures, and similar conditions of the skin and mucous membranes. they may be mixed with a soothing preparation and a steroid preparation for piles. This is a mixture of a local anaesthetic with the soothing preparation anusol and the steroid cream hydrocortisone. They may also be used to numb the pain of a split in the skin of the anus (anal fissure). conditions of the anal canal and surrounding skin are a common cause of complaint. Topical anal preparations are readily available, easy to apply and often work well. There are pitfalls for the general practitioner to be aware of, as not all symptoms are due to my haemorrhoids, doctor.