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I have seen rather an unhelpful GP today due to severe anal discomfort that has slowly got worse over the last two weeks...I am now in agony. I refused a digital examination as I know my body could not tolerate this, although I do understand it made it difficult for the GP. She is treating me for proctitis and has prescribed an internal foam using an applicator.My problem is that everything is so sore and my sphincter muscle naturally very tight, and I think there might also be a fissure there I can't insert the wretched thing. Any practical tips please? Thank you.


The piles cream with the local anaesthetic in is very good, germaloid cream? Best to apply it at least 10 minutes before you need to go - excellent stuff. Good luck @Regalo :x::x:


Thanks! Advice gratefully received!

Quote from @OFJ:
The piles cream with the local anaesthetic in is very good, germaloid cream? Best to apply it at least 10 minutes before you need to go - excellent stuff. Good luck @Regalo


I had a bout of this it was awful but it cleared up on it's own when I had a short chemo break and I've not had it again since. I thought I was also constipated so I took lactulose but I think it made it worse. I had baths with coconut oil in then dabbed some around and about I think it helped a bit. It was just a jar of cheap coconut oil the stuff you cook with it's worth a try makes your skin soft at least .
Good luck xxx I hope it settles soon for you

Charlotte Nurse Advisor

Dear @Regalo,

If the anal sphincter muscle is very tight and it is painful for you to pass stool you could well have a fissure there. If the other ointments either don't work (or can't be introduced due to pain) then it might be worth your GP prescribing some GTN ointment which is specifically for the treatment of fissures. This cream helps to relax the anal sphincter muscle and allow the fissure to heal. The foam enema then can be applied to treat the proctitis.

Most fissures can be seen externally so a digital examination is not required to diagnose one. Perhaps your GP could take another look but in many cases colorectal surgeons prescribe the GTN ointment based on the symptoms alone even if a fissure cannot be clearly identified.

With kind regards,



Thank you I thought. I think I struck unlucky with this GP as I know from previous experience that a fissure can be seen without a digital examination. Her attitude wasn't particularly helpful when you are at a low ebb and feeling vulnerable. I really appreciate your very helpful response.



I'm an IBD patient and when I'm in a nasty flare with proctitis as a side effect I use instilagel it's used as a mild numbing gel for when men are catherterised it works so well for the sensitive are your in need off. Hope your in less pain now than a few days ago :x:


Thanks for all your responses...turns out GP was wrong and inserting predisol foam was not the best idea as I have a deep anal fissure. Saw colorectal consultant on Wednesday and operated on on Thursday. Can't fault the NHS on moving quickly. Trying Botox injections to see if this helps....I couldn't take any more of the total agony I was in. Difference of opinion as to whether it is a side effect of chemo or just bad luck.

Bear G

Glad it's getting sorted @Regalo