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Anal fissures and breastfeeding

Anal fissures are very painful. They may initially be treated as piles but simple treatment does not heal them

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Anal fissures are small tears in the inside in the lining of the large intestine near the anus. Sometimes they do not heal and produce severe pain. This may be treated with glyceryl trinitrate ointment (Rectogesic™) 0.2% or 0.4%. The ingredients may cause a headache and/or hot flush for the mother but there are no reports of adverse effects in babies whose mothers have applied it.

Use during breastfeeding is unlicensed.  It is assumed that diltiazem cream would similarly not affect the baby, but no research has been identified.

Both glyceryl trinitrate ointment and diltiazem cream are compatible with breastfeeding


•             Taylor T, Kennedy D. Safety of topical glyceryl trinitrate in the treatment of anal fissure in breastfeeding women. Birth Defects Research Part a-Clinical and Molecular Teratology. 2008; 82:411.

•             NICE 2% Topical diltiazem hydrochloride for chronic 2013: anal fissurehttps://www.nice.org.uk/advice/esuom3/resources/2-topical-diltiazem-hydrochloride-for-chronic-anal-fissure-pdf-17548582597

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