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 .
Botulinum toxin injection versus internal anal sphincterotomy for the treatment of chronic anal fissure
BACKGROUND Anal fissure is a chronic condition characterized by painful defecation and rectal bleeding . The aim of this study was to compare injection of botulinum toxin versus surgical sphincterotomy for treatment of chronic anal fissure . PATIENTS AND METHODS In a quasi-experimental trial in a university hospital in Kerman , 50 patients diagnosed with chronic anal fissure received 20 units botulinum toxin ( n=25 ) or underwent lateral internal sphincterotomy ( n=25 ) . All patients were evaluated for pain , bleeding and healing of the fissure from one to six months later by another surgeon . The data was analyzed by SPSS software with the Mann-Whitney and Fisher ’s exact tests . RESULTS One month after treatment , the rate of healing and bleeding in the operation group was better than in the toxin group ( P<0.05 ) , while pain was equal . After two months , none of the patients in either group had complications . After six months follow-up , bleeding , pain and healing were better in the operation group . CONCLUSION In the clinical evaluation , botulinum toxin is an effective alternative nonsurgical modality for the treatment of chronic anal fissure . We recommend botulinum toxin as the first step in treatment because of the 60 % chance of cure with an easily performed treatment
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 .