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 .
[Efficacy of anal dilators in the treatment of acute anal fissure. A controlled clinical trial].
Procedures involving the use of anal dilators or topical nitroderivatives for the treatment of anal fissure are efficacious , economic and safe . The aim of our study was to compare the efficacy of two conservative treatments - passive dilation with anal dilators or topical nitroderivatives - in reducing anal pressure and resolving anal fissures . A total of 40 patients with a clinical diagnosis of acute anal fissure in the absence of hypotonic anal sphincter , abscess or perianal fistula , haemorrhoidal thrombosis , chronic inflammatory bowel disease or lower gastrointestinal neoplasia were r and omly assigned to treatment with dilators ( 20 patients ) or topical nitroderivatives ( 20 patients ) . After 4 weeks of treatment , 90 % of patients treated with dilators and only 45 % treated with topical nitroderivatives showed complete resolution of their anal fissures and a reduction of sphincter hypertone . After 12 weeks , 2/18 patients successfully treated with dilators and 1/9 patients successfully treated with topical derivatives presented recurrence of the anal fissure . The use of anal dilators would appear to induce better resolution of acute anal fissures than topical nitroderivates , as confirmed by the low relapse rate at 12 weeks
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 .