Brief Answer:
not to be applied together, please tell me the symptoms.

Detailed Answer:
Hi.
Thanks for your query.I could go through much of your discussion with our esteemed specialists.
Read and understood your history and concerns:

Good to know that results of colonoscopy were good and a rectal polyp was burnt, and the anal fissure has also healed.
It appears that you still have mild pain and spasms which your Doctor has already told that the body is adopting to the surgery (lateral Sphincterotomy in April this year, as per the history in another query) and disappear with time.

You were applying Nitroglycerin ointment 0.2% thrice daily. Now the recent Surgeon has advised you Shield ointment.
To answer your query first - both the ointments should not be applied together. Understood that you have no headache with Nitroglycerine ointment.

I was just wondering, if you have undergone surgery and if the fissure is healed what is the necessity of applying any of the ointments.
The surgery is done to get a permanent relief.
The fissure can recur only if there is constipation, colitis, intestinal infection, most important the stress and anxiety casing IBS like symptoms and straining too much.

Sitz bath in a tub with warm water twice daily, particularly before and after passing stool gives the best results even for the mild pain and spasms.

I would like to know a few things:
- What is the problem at the moment?
- Are you taking any medicines like probiotics, multivitamins?
- What is the level of stress and anxiety at work/home or otherwise?
- How are the bowel movements?

Taking pre-probiotics will help you maintain a normal bacterial flora and Antioxidants in the form of multivitamins will help you have good strength to the healing area, for the skin that cuts in fissure and the sphincters that has been released.

I shall be happy to assist you more once you answer the above questions.

Take care.

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Brief Answer:
As detailed.

Detailed Answer:
Hi.
Loved the way you sent the reply as attachment of the snapshot, what a way the technology helps us all; and even in medical field.

Read and re-read the previous conversations and the one you have sent now.

My thoughts:
You may please continue Shield ointment whenever necessary as it is helping you.
Your problem now is discomfort in sitting position that you have to shift the weight on either thighs. > Here the best thing that helps all my patients is I advise a pillow like a ring with a hollow in the center and made in such a way that the weight of the body goes through the central portion of the buttocks. (example is like the water filled tube of the old scooters (small wheels)). The pressure on the anal area is totally nullified.

Another thing of concern is: if the stools are dry, you get spasms and feeling of incomplete defecation/ evacuation. > This gives me a thought about the possibility of the mild form of IBS- irritable bowel syndrome, may be related to the stress/anxiety. Additions of some medicines like anxiolytic with antispasmodic would help you a lot.
In fact this may alleviate all your symptoms (but need a prescription of the Doctor and you have to discuss with Him).

You get multivitamins and the dose is once a day.
You also get a combination of pre and probiotics to be taken once a day.

Reduce your stress to minimum or zero, most of your problems will improve automatically.

Diet:
Over the months and years, you must have noticed the foods and beverages that either instigate or enhance your problems and should be strictly banned, and the foods and beverages that cause no problems at all or some of them in fact help in passing a good stools (like ladies fingers eaten raw or cooked).
The only basic rule is to continue taking those things that do not cause any problems and it is always the patient who alone can know what suits him and what does not.

I hope this answer helps you to have better control of your symptoms or may in fact be cured.

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Brief Answer:
Better to hold / stop

Detailed Answer:
Great to know your are already using a doughnut pillow, please continue on.

Shield ointment contains lidocain, hydrocortisone Acetate, Zinc Oxide and Allantoin hence it is more useful when you have active fissure. Since it helped you, please use it whenever your symptoms are present or more. I doubt how much will it be useful once the fissure heals- mean with intact skin.
I am worried about the wetness it keeps, the steroid it contains, may be doing the early healing, relieving the symptoms but not good for intact healing skin. Hence better avoided if it is not giving any advantage.

I hope this clears your doubts and take care, observe carefully and see and tell me the effects you have noticed with this.

Rest of the things as available as OTC.

Please feel free to clear any doubts if you have. To repeat- no stress and anxiety.

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Brief Answer:
Proper sitz bath is the best- just before and immediately after passing BM

Detailed Answer:
Thanks for your feedback.
The major complaint you have now is > after every bowel you feel a spasm (like a pressure on that area and a feeling like bowels not evacuated completely). This last for 1 or 2 hours and then you are completely normal.
This indicates that there is still inflammation that is is instigated more due to your fear of passing motion and reflex spasm.
The moment you go for passing a motion the fear factor works and due to it the muscles knowingly or unknowingly go into spasm causing the problem you have.
This is where your bowel training works.
You should learn to relax the sphincters of anal canal and your problem will go away. This is weell aided by having sitz bath immediately before and after passing motion..
Please try this and there may not be necessity for any ointments.

Nitroglycerin ointment is a nitrate. It works by relaxing (widening) blood vessels.
Ans as you know the Shield ointment contains lidocain, hydrocortisone Acetate, Zinc Oxide Allantoin.
Both these work where there is a fissure. Since the fissure is healed, there may not be necessity of these and can in fact cause problem by keeping the area wet. This is the reason of my saying against. But if you are feeling that a particular ointment is helping and not causing any local or systemic problem, you may use either of them.
Just give a rest- no ointments for a few days- only good sitz bath and see the difference for yourself and continue the modality which suited you the most.
Our ultimate aim is that you be completely asyptomatic

Isabgol husk is to be taken in a glass of warm water after allowing it to soak for 10 minutes for it to be more useful.

Please give me feedback about the effectiveness of sitz bath alone / with Nitrogycerine ointment.

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Brief Answer:
You are most welcome.

Detailed Answer:
Thanks for your appreciation.
Surely, try sitz bath just before and after stool and give me feedback.

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