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 .
Treatment of chronic anal fissure with topical glyceryl trinitrate: a double-blind, placebo-controlled trial.
BACKGROUND Topical glyceryl trinitrate ( GTN ) may produce healing of anal fissure by decreasing the high resting anal sphincter pressure in these patients . The present study assessed the efficacy of GTN in chronic anal fissure in a double-blind placebo-controlled trial . METHOD Patients with chronic anal fissure ( for more than 8 weeks ) underwent measurement of maximum anal resting pressure ( MARP ) before and 12 minutes after application of either 0.2 % GTN or placebo ointment in a r and omized manner . They then received twice-daily local application of their respective ointment for 6 weeks . Symptoms and healing of fissure were assessed ; patients were evaluated at 3 months for evidence of relapse . RESULTS 19 adult patients ( 12 men ) were studied ; 10 received GTN and 9 placebo .  Mean ( SD ) MARP decreased from 131.0 ( 32.3 ) cm H2O to 93.5 ( 28.4 ) cm H2O ( p<0.05 ) with GTN and from 150.5 ( 36.9 ) cm H2O to 142.8 ( 35.0 ) cm H2O ( p = ns ) with placebo .  Fissure healed in 7 of 10 patients treated with GTN and 2 of 9 patients treated with placebo ( p<0.05 ) . There was no relapse of fissure in either group . CONCLUSION Local application of GTN was effective in healing chronic anal fissure
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 .