anal fissure

[pharm]

Anal fissure needing treatment. Sitz bath continued. Proctofoam ineffective. Options: xylocaine gel, topical diltiazem, topical nitroglycerin. Breastfeeding. Best option? Thank you !

[mmilla]

Dear pharm,
Xylocaine gel would probably be the best choice. There have been
many studies done on the transfer of lidocaine into milk and these studies
show that the amount transferred is minimal and probably safe to use while
Breastfeeding. Topical diltiazem would also be effective.
Avoid nitroglycerine if possible.
Some also use injections of Botox, which would be safe as well, but some
question its efficacy.

Maria Milla, MD/Thomas Hale Ph.D.
InfantRisk Center