Botox and CCBs were equivalent to GTN in efficacy with fewer adverse events .
No medical therapy came close to the efficacy of surgical sphincterotomy , though none in these RCTs was associated with the risk of incontinence .
Medical therapy for chronic anal fissure , acute fissure and fissure in children may be applied with a chance of cure that is marginally better than placebo , and , for chronic fissure in adults , far less effective than surgery
BACKGROUND Because of the disability associated with surgery for anal fissure and the risk of incontinence , medical alternatives for surgery have been sought .
Most recently , pharmacologic methods that relax the anal smooth muscle , to accomplish reversibly what occurs in surgery , have been used to obtain fissure healing .
OBJECTIVES To assess the efficacy and morbidity of various medical therapies for anal fissure .
Comparison of Topical Glyceryl Trinitrate Ointment and Oral Nifedipine in the Treatment of Chronic Anal Fissure
Abstract This study was design ed to compare the effect of topical glyceryl trinitrate ( GTN ) and oral nifedipine treatments on maximal anal resting pressure ( MarP ) and subsequently to assess their effectiveness in healing of chronic anal fissure ( CAF ) . Patients were allocated r and omly to receive either oral nifedipine retard ( 10 patients ) 20 mg twice daily or instructed to apply glyceryl trinitrate ( 0.2 percent ) ointment ( 10 patients ) into the lower half of the anal canal twice daily . They were review ed and assessed at the first visit and every fortnight for measurement of MARP , pain scores , blood pressure , pulse rate , healing of the fissure and adverse effects . Treatment were continued until healing had occurred or for up to 8 weeks . MARP values before and after application of the GTN ointment was 113.2 cm H2O and 72.5 cm H2O respectively ( P < 0.001 ) . Nifedipine caused a reduction in mean MARP from 105.2 to 74.0 cm H2O ( P < 0.001 ) . Linear analogue pain scores were significantly reduced after 2 weeks treatment with GTN and nifedipine ( P < 0.001 ) and continued throughout the treatment period . At the end of the study ; 7 of the 10 patients in the GTN group were deemed to be healed ( 5 ) or improved ( 2 ) , compared with 6 of the 10 patients in the nifedipine group ( 5 healed , 1 improved ) . Headaches occurred in 3 patients in the GTN group , compared with one patient in the nifedipine group . There was no significant difference between GTN and nifedipine in terms of reduction in MARP and pain score , healing of the fissure and incidence of early recurrence and side effects of treatments . We conclude that GTN ointment and oral nifedipine are equally effective in the treatment of chronic anal fissure
Botox and CCBs were equivalent to GTN in efficacy with fewer adverse events .
No medical therapy came close to the efficacy of surgical sphincterotomy , though none in these RCTs was associated with the risk of incontinence .
Medical therapy for chronic anal fissure , acute fissure and fissure in children may be applied with a chance of cure that is marginally better than placebo , and , for chronic fissure in adults , far less effective than surgery
BACKGROUND Because of the disability associated with surgery for anal fissure and the risk of incontinence , medical alternatives for surgery have been sought .
Most recently , pharmacologic methods that relax the anal smooth muscle , to accomplish reversibly what occurs in surgery , have been used to obtain fissure healing .
OBJECTIVES To assess the efficacy and morbidity of various medical therapies for anal fissure .