Q: Patient developed lower GI bleed in ICU. GI service after scope diagnosed anal fissure and prescribed Cardizem. Is this a mistake?

Answer: No

Cardizem (Diltiazem) is frequently used in the treatment of anal fissures - either via oral route or can be applied topically!

It has a very good short term success rates and provide temporary relief till surgical intervention is done, if required. Local application of it relaxes the sphincter muscle, and allows the healing to proceed.