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 anal fissures using a combination of minoxidil and lignocaine: a randomized, double-blind trial.
AIM Anal fissures are associated with hypertonia of the internal anal sphincter and pain . We evaluated the efficacy of local application of a combination of minoxidil and lignocaine in healing anal fissures . METHODS In this prospect i ve , r and omized , double-blind study , 90 patients with anal fissure were recruited . Patients received local applications of ointments containing 5 % lignocaine ( n=28 ) , 0.5 % minoxidil ( n=36 ) , or both ( n=26 ) . Healing of anal fissure at 6 weeks was used as the primary end-point . RESULTS Rates of complete healing of fissure were similar in the three groups ( lignocaine alone 8/27 , minoxidil alone 10/34 , combination 7/22 ; p = ns ) . Mean ( SD ) time taken for complete healing with combination treatment [ 1.9 ( 0.6 ) weeks ] was significantly shorter than that with minoxidil alone ( 3.1 [ 1.7 ] weeks ; p=0.001 ) or with lignocaine alone ( 3.3 [ 0.8 ] weeks ; p=0.002 ) . Rates of pain relief were similar in the three groups . Stoppage of bleeding occurred more often with combination treatment than with lignocaine alone . No patient had systemic or local side effects . CONCLUSION Combination treatment with minoxidil and lignocaine helps in faster healing of anal fissures and provides better symptomatic relief than either drug alone
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 .