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 .
Double blind randomised controlled trial of topical glyceryl trinitrate in anal fissure
AIMS To determine the effectiveness and safety of topical glyceryl trinitrate ( GTN ) in the management of acute anal fissure in children . METHODS Individual children were r and omised to receive GTN paste or placebo for six weeks in addition to oral senna and lactulose . Patients took laxatives alone for a further 10 weeks . Each week a research nurse telephoned families to assess pain scores and give advice . Main outcome measures were vali date d st and ardised pain scores and time to painless defaecation . RESULTS Forty subjects were recruited from 46 eligible children ; 31 children completed the trial ( 13 in the GTN group and 18 in the placebo group ) . No differences in the proportion of those achieving pain free defaecation with relation to time were seen between the two groups . Similarly , there were no significant differences in pain scores between the two groups over the 16 week study period . However , in both groups pain scores had decreased significantly . There were no differences in the incidence of rectal bleeding , faecal soiling , presence of visible fissure , skin tag , or faecal loading at outpatient review at the time of recruitment , or at 6 weeks and 16 weeks . No serious adverse effects were observed . CONCLUSIONS This study suggests that 0.2 % GTN paste is ineffective in the treatment of acute anal fissures in childhood . However the overall fissure healing rate is high ( 84 % ) with associated reduction in pain scores , suggesting that a nurse based treatment programme can achieve a high rate of fissure healing
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 .