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 .
Controlled Dose Delivery in Topical Treatment of Anal Fissure: Pilot Study of a New Paradigm
Purpose Topical nitroglycerin has been widely used as a means for avoiding surgery in patients with anal fissure . However , nitroglycerin has not been universally accepted for this application because of inconsistency of efficacy and side effects . This study compares conventional digital application with precise intra-anal dosing of nitroglycerin using a specialized dose-delivery device and anal cannula . Methods Twenty-six consecutive patients ( 13 males ) with chronic anal fissure and no previous treatment were r and omly allocated to receive 0.75 ml of 0.3 percent nitroglycerin ointment ( 2.25 mg nitroglycerin ) t.i.d . intra-anal using the cannula ( Group A ) or perianally with the gloved finger ( Group B ) . Nitroglycerin dosage was controlled in Group A by the dose-delivery device connected to the cannula and by single-dose preloaded syringes in Group B. Results Anal manometry : pressure reduction after application of nitroglycerin was 47 ± 18.6 in Group A and 20.7 ± 13.4 percent in Group B ( P < 0.01 ) . Headaches were reported by 1 of 10 patients in Group A and 10 of 12 patients in Group B ( P = 0.0027 ) . Seven patients of Group B had to be crossed to intra-anal treatment as a result of intensity of headaches . Pain relief was noted by 8 of 10 and 9 of 12 patients in Groups A and B , respectively ( P = 0.6 ) . Sphincterotomy was required in only 13.6 percent of all patients . Conclusions Controlled intra-anal dosing of topical nitroglycerin produces a significantly greater reduction in sphincteric pressure and lower incidence of headaches than with perianal administration of the same dose ofointment . These results suggest a new paradigm for increasing safety and efficacy of dose-dependent prescription anal topical medications
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 .