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 .
Chronic anal fissures treated with botulinum toxin injections: a dose‐finding study with Dysport®
Botox ® injection of the anal sphincter muscle cures  chronic uncomplicated anal fissures in up to 80 % of patients . This study examines the therapeutic efficacy and side effect profile of the British botulinum product Dysport ® .  Fifty patients ( 29 women ) were recruited to participate in this r and omized dose‐finding study , their mean age being 32.9 years . The low dose group A was treated with a total dose of 20 U injected in two sites each lateral to the fissure , the high dose group B was treated with 40 U. Eighty‐two percent of patients were pain‐free within a week following the injections . The fissure was healed in 78 % of treated patients after 3 months . Three patients relapsed within 6 months . The most common adverse side effect was transient incontinence ( n = 4 ) . Clinical outcome was not significantly different between the two treatment groups . The low dose can therefore be regarded sufficient for the treatment of anal fissure . Therapeutic efficacy was equivalent to published data on Botox treatment . Both Dysport ® and Botox ® can therefore be used to treat chronic uncomplicated anal fissures . Both Dysport ® and Botox ® therapy are well tolerated , can be performed on an out‐patient basis and avoid the risk of permanent faecal incontinence which complicates surgical treatment of anal fissures
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 .