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 .
Maintenance Therapy with Unprocessed Bran in the Prevention of Acute Anal Fissure Recurrence
The effect of unprocessed bran in a dose of 5 g three times daily and a dose of 2.5 g three times daily for one year on the recurrence rate of anal fissures was studied in a double-blind , placebo-controlled trial in 90 patients with recently healed acute posterior anal fissures . Fifteen patients ( 16.6 % ) were withdrawn before the code was broken due to failure to follow the trial protocol for various reasons . Significantly fewer recurrences occurred in patients receiving bran 5 g throe times daily ( recurrence rate 16 % , 95 % confidence limits , 4.54 to 36.08 ) when compared with patients receiving bran 2.5 g three times daily ( 60 % ; 38.67 to 78.87 ) ( P<0.01 ) and with patients receiving placebo three times daily ( 68 % ; 46.50 to 85.05 ) ( P<0.01 ) . No significant difference in recurrences was found between patients on bran 2.5 g and those on placebo
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 .