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The internal anal sphincter has a calcium dependent mechanism to maintain tone, and also receives an inhibitory extrinsic cholinergic innervation. It may therefore be possible to lower anal sphincter pressure using calcium channel blockers and cholinergic agonists without side effects. In the first study subjects were given oral 60 mg diltiazem or placebo on separate occasions. They were then given diltiazem once or twice daily for four days. Chronic anal fissures have traditionally been treated by surgical division of the internal anal sphincter, causing a fall in anal canal pressure and allowing fissure healing.
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Diltiazem is used to treat high blood pressure hypertension and to prevent chest pain angina. It may help to increase your ability to exercise and decrease how often you get chest pain. Diltiazem may also be used to control your heart rate if you have a fast or irregular heartbeat such as atrial fibrillation.
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