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 .
Topical Nifedipine With Lidocaine Ointment vs. Active Control for Treatment of Chronic Anal Fissure
Abstract PURPOSE : Chronic anal fissure may be treated by chemical or surgical sphincterotomy . The aim of this study was to test the efficacy of local application of nifedipine and lidocaine ointment in healing  chronic anal fissure .  METHODS : The study was performed according to a prospect i ve , r and omized , double-blind design . One hundred ten patients who gave informed consent were recruited . They received a clinical examination , a question naire to evaluate symptoms and pain , anorectal manometry , and anoscopy . Healing of anal fissure at Day 42 of therapy was defined as the primary efficacy variable of the study . Patients treated with nifedipine ( n = 55 ) used topical 0.3 percent nifedipine and 1.5 percent lidocaine ointment every 12 hours for 6 weeks . The control group ( n = 55 ) received topical 1.5 percent lidocaine and 1 percent hydrocortisone acetate ointment during therapy . Anal pressures were measured by recording resting and maximal voluntary contraction pressures at baseline and at Day 21 . Long-term outcomes were determined after a median follow-up of 18 months . RESULTS : Healing of chronic anal fissure was achieved after 6 weeks of therapy in 94.5 percent of the nifedipine-treated patients ( P < 0.001 ) as opposed to 16.4 percent of the controls . Mean anal resting pressure decreased from a mean value ± st and ard deviation of 47.2 ± 14.6 to 42 ± 12.4 mmHg in the nifedipine group . This represents a mean reduction of 11 percent ( P = 0.002 ) . Changes of maximal voluntary contraction in nifedipine-treated patients were not significant . No changes in mean anal resting pressure and maximal voluntary contraction were observed in the control group . We did not observe any systemic side effect in patients treated with nifedipine . After the blinding was removed , recurrence of the fissure was observed in 3 of 52 patients in the nifedipine group within 1 year of treatment , and 2 of these patients healed with an additional course of topical nifedipine and lidocaine ointment . CONCLUSIONS : Our study clearly demonstrates that the therapeutic use of topical nifedipine and lidocaine ointment should be extended to the conservative treatment of 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 .