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, placebo-controlled trial of glyceryl-trinitrate ointment in the treatment of children with anal fissure.
BACKGROUND Anal fissure in children usually is treated by sitz baths , stool softeners , and analgesic ointments . However , some cases are intractable to the treatment . In recent years , it has been reported that nitric oxide donors such as local glyceryl-trinitrate ( GTN ) ointment causes a reversible chemical sphincterotomy . Although the GTN ointment can be an alternative therapy for adult cases , it has not yet been studied in the children who suffer from anal fissure . METHODS Sixty-five children with anal fissure were divided r and omly into 3 groups . Each group received double-blinded a topical ointment that contained either 0.2 % GTN , 10 % lidocaine , or placebo . These ointments were applied to the lowest part of the anal canal twice daily . Patients were periodically review ed , and the study was ended after 8 weeks . RESULTS Complete healing of the fissure occurred in 26 of 31 ( 83.9 % ) patients treated with GTN , 7 of 14 ( 50 % ) patients treated with lidocaine , and 6 of 17 ( 35.2 % ) treated with placebo . In 29 of 31 ( 93.5 % ) GTN-treated patients , a total relief of symptoms was observed , whereas this occurred in 7 of 14 ( 50 % ) treated with lidocaine and 6 of 11 ( 35.3 % ) in the placebo group . The differences between the study group and control groups were highly statistically significant ( P < .001 ) . CONCLUSION The majority of children suffering from anal fissure will be cured and have relief of symptoms after topical application of GTN ointment to the anal canal
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 .