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 .
Long-term results of topical nitroglycerin in the treatment of chronic anal fissures are disappointing
Several treatments for anal fissure offer different responses and risks for complications . Reversible chemical sphincterotomy with topical nitroglycerin is an alternative to surgical sphincterotomy . The aim of this observational prospect i ve study was to compare the effectiveness of topical nitroglycerin with the conventional medical treatment . Forty-three patients with anal fissure were treated : 22 ( 16 chronic and 6 acute ) received 0.25 % nitroglycerin topically , and 21 ( 16 chronic and 5 acute ) received conventional treatment . Nitroglycerin or placebo was administered in two daily applications for two weeks . Median follow-up was 39 weeks . Healing rate with NTG was 75 % for chronic and 83 % for acute fissures , but recurrence rate for chronic fissures at 9 months was 67 % . Healing rate with placebo for chronic fissures was only anecdotical ( 1 out of 16 patients ) . Headache as side effects occurred in 17 cases ( 77 % ) . In conclusion , both treatments were effective for acute fissures , whereas for chronic ones NTG had a high healing rate but also a high recurrence rate
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 .