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 .
The use of glyceryl trinitrate (GTN) in the treatment of chronic anal fissure in children.
BACKGROUND 0.2 per cent topical glyceryl trinitrate ( GTN ) ointment heals up to two-thirds of  chronic anal fissures in adults although many patients experience troublesome headaches . This double blind r and omised pilot study assessed the efficacy and side effects of 0.1 and 0.05 per cent GTN ointment in treatment of chronic anal fissures in children . MATERIAL / METHODS 15 consecutive children with chronic anal fissures were r and omised to receive either 0.05 or 0.1 per cent GTN ointment applied topically twice daily for eight weeks . Clinical review was undertaken at weeks 4 and 8 and questions relating to symptoms and the incidence of headache were asked . RESULTS The median age of the 15 ( 8 male ) patients was 6 years ( range 3 - 13 ) . There were 5 anterior and 10 posterior fissures . The median duration of symptoms was 9 ( 3 - 30 ) months . 13/15 ( 86.7 % ) patients were taking laxatives at the time of referral . Fissure healing was complete at 8 weeks in all seven patients who received 0.05 % and in 5/8 ( 62.5 % ) patients using the 0.1 % ointment ( Fisher 's exact test , not significant ) . One patient from each arm experienced headaches during the first week of the trial which resolved without treatment and did not affect compliance . There were no other side effects . CONCLUSIONS Topical glyceryl trinitrate ointment is effective in healing chronic anal fissures in children .  Healing rates and side effect profile are comparable when either 0.05 or 0.1 per cent ointment is used
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 .