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 .
Efficacy and Safety of Botulinum Toxin A Injection Compared with Topical Nitroglycerin Ointment for the Treatment of Chronic Anal Fissure: A Prospective Randomized Study
OBJECTIVES : To evaluate the efficacy and safety of botulinum toxin A injection compared with topical nitroglycerin ointment for the treatment of  chronic anal fissure ( CAF ) . METHODS : Fifty out patients with CAF were r and omized to receive either a single botulinum toxin injection ( 30 IU Botox ® ) or topical nitroglycerin ointment 0.2 % b.i.d . for 2 wk . If the initial therapy failed , patients were assigned to the other treatment group for a further 2 wk . If CAF still showed no healing at wk 4 , patients received combination therapy of botulinum toxin and nitroglycerin for 4 additional wk . Persisting CAF at wk 8 was treated according to the investigator 's decision . Healing rates , symptoms , and side effects of the therapy were recorded at wk 2 , 4 , 8 , 12 , and 24 after r and omization . RESULTS : The group initially treated with nitroglycerin showed a higher healing rate of CAF ( 13 of 25 , 52 % ) as compared with the botulinum toxin group ( 6 of 25 , 24 % ) after the first 2 wk of therapy ( p < 0.05 ) . At the end of wk 4 , CAF healed in three additional patients , all receiving nitroglycerin after initial botulinum toxin injection . Mild side effects occurred in 13 of 50 ( 26 % ) patients , all except one were on nitroglycerin . CONCLUSIONS : Nitroglycerin ointment was superior to the more expensive and invasive botulinum toxin injection for initial healing of CAF , but was associated with more but mild side effects
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 .