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 .
Isosorbide dinitrate in the treatment of anal fissure: a randomised, prospective, double blind, placebo-controlled trial.
OBJECTIVE To assess the efficacy of isosorbide dinitrate in healing anal fissures . DESIGN R and omised , prospect i ve , double blind , placebo controlled trial . SETTING Teaching hospital , The Netherl and s. SUBJECTS 37 consecutive subjects with anal fissure diagnosed in the surgical outpatient department . INTERVENTIONS After r and omisation , 20 patients were given isosorbide dinitrate , and 17 patients placebo . MAIN OUTCOME MEASURES Healing of anal fissure , recurrence , and tolerance . RESULTS Both groups were treated for a median ( range ) of 5 weeks ( range 1 - 10 ) . After this period , 17 in the isosorbide group had healed compared with 6 controls ( p < 0.003 ) . The fissure recurred in 2 patients who had had an initial good response to isosorbide , and in 2 in the control group . Side effects ( particularly headache ) were more common after isosorbide dinitrate , but not significantly so ( 9/20 compared with 3/17 ) . CONCLUSIONS Isosorbide dinitrate is an effective treatment for anal fissure , and is significantly better than placebo
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 .