Rectal Compounding

Key Takeaways

• Rectal compounding means a pharmacist makes a prescription cream, gel, or ointment to the exact strength and combination your doctor orders.
• Common fissure treatments like diltiazem 2%, nifedipine 0.3%, and nitroglycerin 0.2% are mainly available through compounding pharmacies.
• Combination formulas can add lidocaine for numbing, or combine several soothing ingredients in one tube, like our MSA Fissure Gel.
• A prescription is required for every compound, written for each individual patient.
• Custom formulas are welcome. Prescribers can call our lab directly at 231-683-1708.

Rectal compounding gives you prescription creams, gels, and ointments made to the exact strength and combination your doctor orders. Problems like anal fissures and hemorrhoids are more common than most people realize, and they can make sitting, walking, and going to the bathroom painful. Many of the treatments doctors prescribe for them aren’t sold ready-made, so they have to be prepared by a compounding pharmacy.

At Watkins Pharmacy in Muskegon, our pharmacists make these medications in-house. We’re a PCAB-accredited compounding pharmacy and a family-owned West Michigan pharmacy. We know this isn’t the easiest thing to talk about. We’ll keep it simple, private, and respectful.

What Is Rectal Compounding?

Compounding means a pharmacist prepares a medication from individual ingredients instead of pulling a pre-made product off the shelf. For rectal care, that usually means a cream, gel, or ointment applied to the skin around the anus.

This matters because some of the most commonly prescribed fissure treatments, like diltiazem and nifedipine applied to the skin, are mainly available through compounding pharmacies. Compounding also lets your doctor choose the exact strength, add a numbing ingredient, or combine several ingredients into one tube so you’re not juggling multiple products.

Every compounded medication at Watkins requires a written prescription for each individual patient. Your doctor decides what you need, and we make it.

Fissure Relief Creams and Gels

An anal fissure is a small tear in the lining of the anus. It can cause sharp pain during and after bowel movements, and sometimes a little bleeding. The muscle around the anus often tightens in response, which can make the tear slower to heal. The medications in this group are commonly prescribed to help that muscle relax so the area has a chance to heal.

Diltiazem 2% Rectal Gel: Diltiazem is one of the most commonly prescribed compounded treatments for anal fissures. Our 2% gel is a simple, single-ingredient formula. Size: 50 g tube.

Diltiazem 2% / Lidocaine 2% Cream: The same diltiazem 2% strength, combined with lidocaine, a numbing ingredient that can help ease pain while you heal. Size: 50 g tube.

Nifedipine 0.3% Rectal Gel: Nifedipine works in a similar way to diltiazem and is another common choice for fissures. Your doctor may prefer one or the other depending on your situation. Size: 50 g tube.

Nifedipine 0.3% / Lidocaine 1% Ointment: Nifedipine 0.3% combined with lidocaine 1% for added numbing relief, in an ointment base. Size: 50 g tube.

Nitroglycerin 0.2% Ointment: Nitroglycerin ointment is another long-used option for fissures. It also helps relax the muscle around the anus. Sizes: 30 g or 50 g tube.

MSA Fissure Gels

These multi-ingredient gels combine several soothing and protective ingredients in one product.

MSA Fissure Gel: A combination of misoprostol, hydrocortisone, sucralfate, lidocaine, and coenzyme Q10. Hydrocortisone helps calm inflammation, lidocaine numbs, and sucralfate is used for its protective, coating properties. Size: 50 g tube.

MSA Fissure Gel with 0.3% Nifedipine: Our MSA Fissure Gel with nifedipine 0.3% added, so your doctor can combine muscle-relaxing and soothing ingredients in a single tube. Size: 50 g tube.

Skin Irritation and Rash

Devos Magic Butt Cream: A blend of Desitin, Mylanta, and nystatin made for irritated, raw skin in the diaper area. Sizes: 30 g, 60 g, or 90 g.

Need Something Different?

Custom formulas are welcome. If your doctor wants a different strength, a different base, or a combination that isn’t listed here, our lab can work with them directly. Prescribers can reach the lab at 231-683-1708.

Why Choose a Compounded Rectal Cream?

• Made to your prescription. Your doctor chooses the exact strength and ingredients, whether that’s diltiazem alone or diltiazem with lidocaine.
• Access to treatments you can’t easily buy. Many fissure treatments aren’t sold as ready-made products, and compounding is how patients get them.
• Fewer tubes to juggle. Combination formulas put several ingredients into one product.
• Sizes that fit your treatment. Some formulas come in more than one size, so you get what you need.
• Accredited quality. Watkins is a PCAB-accredited compounding pharmacy.
• Real pharmacists who get it. You can call and talk to someone who handles these prescriptions every day. No awkwardness, no judgment.

How to Get a Compounded Rectal Cream

Getting a compounded medication is easier than most people expect.

1. Talk to your doctor. Tell your doctor about your symptoms and ask whether a compounded cream or gel is right for you. If you’d like, you can share this page or our prescription form with them.
2. Your doctor sends the prescription to Watkins. Your doctor can fax, call, or email the prescription to us. Our team verifies every prescription with the prescriber’s office.
3. We make your medication. Our pharmacists compound it in our Muskegon lab. Then you can pick it up at our pharmacy.

Questions along the way? Call us at (231) 739-7158.

For Prescribers

Watkins Pharmacy is a 503A, PCAB-accredited compounding pharmacy. We compound the rectal care formulas listed above and welcome custom formulas.

How to send a prescription

• Fax: 231-737-1329
• Email: watkinspharmacy@watkinspharmacy.com
• Lab direct: 231-683-1708
• Main pharmacy: (231) 739-7158

Our prescription form includes fields for patient name, date of birth, address, phone, and allergies, along with medication, quantity, refills, directions (sig), physician name and signature, DEA number, and office phone. Each compound requires a written prescription for an individual patient, and every prescription is verified with the prescribing office.

To discuss a custom formula, strength, or base, call the lab directly.

Frequently Asked Questions