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 .
Local nitroglycerin for treatment of anal fissures: An alternative to lateral sphincterotomy?
PURPOSE : Nitric oxide is an important neurotransmitter mediating internal anal sphincter relaxation . Patients suffering from fissure-in-ano were treated with topical nitroglycerine . The clinical evidence for therapeutic adequacy was examined in a prospect i ve , r and omized study . METHODS : The study included 35 patients with acute and chronic anal fissures . In Group A , including 20 patients with the clinical diagnosis of acute ( 12 patients ) and chronic ( 8 patients ) anal fissures , treatment consisted of topical nitroglycerine . Group B , consisting of 15 patients ( 10 acute and 5 chronic fissures ) , received topical anesthetic gel during therapy .  Manometry was performed before and on days 14 and 28 in the course of topical application of either 0.2 percent glyceryl trinitrate ointment or anesthetic gel ( lignocaine ) .  Anal pressures were documented by recording the maximum resting and squeeze pressures . RESULTS : In 60 percent of cases treated with topical nitroglycerine ( Group A , 11 acute ( 91.6 percent ) and 1 chronic ( 12.5 percent ) ) , anal fissure healed within 14 days , in contrast to Group B in which no healing was observed . The healing rate after one month was 80 percent ( 11 acute ( 91.6 percent ) ; 5 chronic ( 62.5 percent ) ) in Group A and was significantly superior to Group B ( healing rate , 40 percent : 5 acute ( 50 percent ) ; 1 chronic ( 20 percent ) ) . DISCUSSION : Previously increased maximum resting pressures decreased from a mean value of 110 to 87 cm H2O . This represents a mean reduction of 20 percent ( P=0.0022 ) . We also noted a significant decrease in squeeze pressures ( from 177.8 to 157.9 cm H2O ( 11 percent ) ) . However , anal pressures did not decrease significantly in the four chronic fissure patients from Group A , whose fissures only healed after 28 days . Similarly to these Group A chronic fissure patients , no significant anal pressure reduction was observed in any Group B patients . Except for mild headache ( 20 percent ) , no side effects of treatment were reported . CONCLUSIONS : Topical application of nitroglycerine represents a new , easily h and led , and effective alternative in the treatment of anal fissures . All of our patients reported a dramatic reduction in acute anal pain . However , it should be noted that a lack of sphincter tone reduction is a likely reason for the great tendency of chronic anal fissures to recur
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 .