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 .
The anal dilator in the conservative management of acute anal fissures
Patients presenting with acute anal fissure were r and omized into two treatment groups in a prospect i ve clinical trial . Both groups received treatment for 3 weeks with a stool softener and lignocaine jelly . Those entered in group 1 ( 35 patients ) were asked in addition to insert an anal dilator ( no. 2 ) twice daily while those in group 2 ( 31 patients ) applied the anaesthetic jelly without a dilator . At 6 weeks 11 ( 31·4 per cent ) patients in group 1 and 12 ( 38·7 per cent ) patients in group 2 had been referred for sphincterotomy owing to failure of the treatment . At 6 months this figure had risen to 14 ( 40 per cent ) in group 1 and 15 ( 48·4 per cent ) in group 2 . This difference was not statistically significant , suggesting that the addition of a dilator to the conservative treatment regimen did not diminish the likelihood of surgery
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 .