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 Comparison of the Effects of Diltiazem and Glyceryl Trinitrate Ointment in the Treatment of Chronic Anal Fissure: A Randomized Clinical Trial
Purpose Anal fissure is a common problem affecting all age groups with an equal incidence in both sexes . Traditional surgical treatments , like manual anal dilatation or a sphincterotomy , effectively heal most fissures within a few weeks but such procedures may result in anal incontinence . In recent years , various medical therapies have been used for the treatment of chronic anal fissure without fear of incontinence . Methods Ninety patients with a symptomatic anal fissure were r and omly divided into three groups . Group I was treated with 2 % diltiazem ointment , Group II was treated with 0.2 % glyceryl trinitrate ( GTN ) ointment , and Group III was kept as the control group . The improvement in the signs and symptoms , the time taken for healing , and side effects were recorded in each group . The patients were followed up monthly and then every 3 months for any recurrence of fissure . Comparative evaluations of the three groups regarding an improvement in symptoms , progress in healing , appearance of side effects , and recurrence were made using the Tukey HSD test . Results Diltiazem ointment was found to be superior regarding pain relief , fewer side effects , and late recurrence as compared with GTN ointment . Conclusion Diltiazem ointment ( 2 % ) and GTN ointment ( 0.2 % ) are both effective treatment modalities for chronic anal fissure , with diltiazem giving better patient outcome
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 .