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 randomized trial of botulinum toxin vs lidocain pomade for chronic anal fissure.
PURPOSE As lateral sphincterotomy and anal dilatation causes complications , a reversible chemical sphincterotomy method has been recently proposed as an alternative treatment in patients with anal fissure . In this study , the effect of botulinum toxin causing temporary paralysis in internal anal sphincter was compared with that of lidocaine in patients with chronic anal fissure . METHOD A total of 62 out patients were r and omly assigned to receive botulinum toxin or lidocaine pomade . The patients were evaluated before and after two months of treatment with physical examination and anal manometry . Pain and nocturnal pain were scored . RESULTS In an evaluation period of two months , in 24 of 34 patients of botulinum group ( 70.58 % ) , and in six of 28 patients of lidocaine group ( 21.42 % ) showed complete epithelization ( p = 0.006 ) . All patients who had previously reported nocturnal pain became symptom free in botulinum group and in four patients of lidocaine group . Pain following defecation disappeared in 24 patients of botulinum group and in 20 patients of control group ( p = 0.959 ) . There was no adverse effect in both groups . While resting anal pressure and maximum voluntary pressure were significantly low in botulinum toxin group , both parameters did not change in lidocaine group . CONCLUSIONS Botulinum toxin is a reliable and effective method for patients with chronic anal fissure . It can be applied easily without any anesthesia and instrumentation . It is cheaper in comparison with surgical methods and it can be a good alternative treatment in patients with risk of incontinence
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 .