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 .
Safety and Efficacy of New Glyceryl Trinitrate Suppository Formula: First Double Blind Placebo-Controlled Clinical Trial
Purpose This study was design ed to assess the safety and efficacy of 0.2 percent glyceryl trinitrate suppository form in the healing of  chronic anal fissure .  Methods Thirty-four patients with symptomatic chronic anal fissures were assigned to 0.2 percent glyceryl trinitrate suppository ( n = 21 ) or placebo ( n = 13 ) in a double blind design . Patient 's symptom scores were registered at first visit . A vali date d daily chart was given to assess their symptoms on a daily basis . Both groups received psyllium from the beginning of the study . They were assessed at two-week intervals for six weeks . Then , they started a washout period of one month and after that were crossed over for another six weeks . Chi-squared , t-tests , and analysis of variance were used for statistical analysis . Results Complete healing at six weeks was achieved in 12 of 21 patients ( 57 percent ) in the glyceryl trinitrate group and 5 of 13 patients ( 38 percent ) in the placebo ( P < 0.05).The overall healing rates at the end of study were 15 of 21 ( 71 percent ) vs. 11 of 13 ( 84 percent ) in the glyceryl trinitrate and placebo groups , respectively ( P > 0.05 ) . Conclusions Application of 0.2 percent glyceryl trinitrate suppository form represents a new , promising , and effective treatment for 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 .