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 .
Randomised controlled trial shows that glyceryl trinitrate heals anal fissures, higher doses are not more effective, and there is a high recurrence rate
BACKGROUND Topical application of glyceryl trinitrate ( GTN ) ointment heals chronic anal fissures , providing an alternative to the traditional first line treatment of surgical sphincterotomy . AIMS To determine the most effective dose of topical GTN for treatment of chronic anal fissures and to assess long term results . METHODS Seventy consecutive patients with chronic anal fissure , were r and omly allocated to eight weeks treatment with placebo , 0.2 % GTN three times daily , or GTN starting at 0.2 % with weekly 0.1 % increments to a maximum of 0.6 % , in a double blind study . RESULTS After eight weeks fissure had healed in 67 % of patients treated with GTN compared with 32 % with placebo ( p=0.008 ) . No significant difference was seen between the two active treatments . Headaches were reported by 72 % of patients on GTN compared with 27 % on placebo ( p<0.001 ) . Maximum anal sphincter pressure reduced significantly from baseline by GTN treatment ( p=0.02 ) , but not placebo ( p=0.8 ) . Mean pain scores were lower after treatment with GTN compared with placebo ( NS ) . Of fissures healed with placebo 43 % recurred , compared with 33 % of those healed with 0.2 % GTN and 25 % healed with escalating dose GTN ( p=0.7 ) . CONCLUSIONS GTN is a good first line treatment for two thirds of patients with anal fissure . An escalating dose of GTN does not result in earlier healing . Significant recurrence of symptomatic fissures and a high incidence of headaches are limitations of the treatment
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 .