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 .
[A prospective, randomized double-blind study on the treatment of anal fissures with Nitroglycerin ointment].
BACKGROUND Anal fissure is a common disease . Treatment includes conservative measures or surgery . One of the treatment options is topical Nitroglycerin ointment . MATERIAL S AND METHODS We present a prospect i ve , r and omized , double-blind study , encompassing 48 patients suffering from chronic anal fissure . The subjects were divided into three groups according to the dose of Nitroglycerin ointment received -- group I--0 % ( placebo ) , group II--0.2 % ( 0.75 mg ) and group III--0.4 % ( 1.5 mg ) . Demographic data , medical history and physical findings were recorded . Healing , pain relief and adverse events were evaluated during and after the treatment period . RESULTS No significant difference ( p<0.05 ) was found between the groups with respect to patient age , gender , past history , physical examination , amount of ointment used and adverse events .  Thirty three of the 48 ( 69 % ) patients completed the study . No significant differences were found between the groups with respect to the reasons and rates of leaving the study ( p=0.494 ) . Fifteen patients failed to complete the study ; eight patients ( 17 % ) due to headaches  , one patient was operated upon and six patients left the study because of  cooperation problems . No significant difference was found between the groups regarding healing ( p=0.952 ) or pain relief ( p=0.458 - 0.8 according to the type of pain checked ) . CONCLUSIONS According to our study , there was no benefit regarding healing or pain relief , in treating patients suffering from an anal fissure with Nitroglycerin ointment in combination with stool softeners and sitz baths , compared to the same treatment without Nitroglycerin ointment
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 .