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 .
Effectiveness of higher doses of botulinum toxin to induce healing in patients with chronic anal fissures.
BACKGROUND Botulinum toxin induces healing in patients with idiopathic anal fissures . METHODS One hundred-fifty patients with posterior anal fissures were treated with botulinum toxin injected in the internal anal sphincter on each side of the anterior midline . Subjects were r and omized into 2 treatment groups based on the number of units of botulinum toxin injected . Patients in group I were treated with 20 units of botulinum toxin and , if the fissure persisted , were retreated with 30 units . Patients in group II were treated with 30 units and retreated with 50 units , if the fissure persisted . RESULTS The 2 groups were comparable in age , gender distribution , duration of symptoms , resting pressure , and maximum voluntary pressure at anorectal manometry . One month after the injection , examinations revealed complete healing in 55 patients ( 73 % ) from group I and 65 patients ( 87 % ) from group II ( P = .04 ) . Five patients from group II reported a mild incontinence of flatus that lasted 2 weeks after the treatment and disappeared spontaneously . The values of the resting anal pressure ( P=.3 ) and the maximum voluntary pressure ( P = .2 ) did not differ between the 2 groups . At 2 months ' evaluation , a healing scar was found in 67 patients ( 89 % ) from group I and 72 patients ( 96 % ) from group II . A relapse of the fissure was observed in 6 patients ( 8 % ) from group I who had a healing scar at 1 month , and 2 other patients never healed . A persistent fissure was present in 3 patients from group II who had no other symptoms . CONCLUSIONS Botulinum toxin injected into the internal anal sphincter is effective in managing anal fissures and avoiding permanent complications . All patients were treated with the active drug and healed after 1 or 2 successive treatments . The results also confirm that higher doses account for a higher success rate , with little increase in complications or side effects , which is probably related to the diffusion of the toxin to the external sphincter
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 .