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 .
Glyceryl trinitrate for chronic anal fissure—Healing or headache?
PURPOSE : Internal anal sphincterotomy for treating chronic anal fissure can irreversibly damage anal continence . Reversible chemical sphincterotomy may be achieved by anal application of glyceryl trinitrate ointment ( nitric oxide donor ) , which has been reported to heal the majority of patients with anal fissure by inducing sphincter relaxation and improving anodermal blood flow . This trial aim ed to further clarify the role of glyceryl trinitrate in the treatment of chronic anal fissure . METHODS : A total of 132 consecutive patients from nine centers were r and omly assigned to receive 0.2 percent glyceryl trinitrate ointment or placebo twice daily for at least four weeks . The severity of pain and maximum anal resting pressure were measured before and after one week of treatment . Anodermal blood flow was measured before and after application of glyceryl trinitrate or placebo in ten patients . RESULTS : The study was completed by 119 patients ( 59 glyceryl trinitrate and 60 placebo ) , matched for gender , age , duration of symptoms , duration of treatment , site of fissure , previous attempts to treat , pain score , and maximum anal resting pressure . Twenty-nine patients ( 49.2 percent ) healed after glyceryl trinitrate and 31 patients ( 51.7 percent ) healed after placebo ( P= not significant ) . Pain score fell significantly in both groups , in addition to maximum anal resting pressure . Anodermal blood flow improved significantly in seven patients receiving glyceryl trinitrate , but not in the three receiving placebo . Twenty-three patients ( 33.8 percent ) experienced headache and 4 ( 5.9 percent ) , orthostatic hypotension after glyceryl trinitrate . CONCLUSION : This trial fails to demonstrate any superiority of topical 0.2 percent glyceryl trinitrate treatmentvs . a placebo , although the effects of glyceryl trinitrate on anodermal blood flow and sphincter pressure are confirmed . This finding , together with the high incidence of side-effects , should discourage the use of this treatment as a substitute for surgery in 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 .