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 .
A comparison of injections of botulinum toxin and topical nitroglycerin ointment for the treatment of chronic anal fissure.
BACKGROUND AND METHODS Lateral internal sphincterotomy , the most common treatment for chronic anal fissure , may cause permanent injury to the anal sphincter , which can lead to fecal incontinence . We compared two nonsurgical treatments that avert the risk of fecal incontinence . We r and omly assigned 50 adults with symptomatic chronic posterior anal fissures to receive treatment with either a total of 20 U of botulinum toxin injected into the internal anal sphincter on each side of the anterior midline or 0.2 percent nitroglycerin ointment applied twice daily for six weeks . RESULTS After two months , the fissures were healed in 24 of the 25 patients ( 96 percent ) in the botulinum-toxin group and in 15 of the 25 ( 60 percent ) in the nitroglycerin group ( P=0.005 ) . No patient in either group had fecal incontinence . At some time during treatment , five patients in the nitroglycerin group had transient , moderate-to-severe headaches that were related to treatment . None of the patients in the botulinum-toxin group reported adverse effects . Ten patients who did not have a response to the assigned treatment - 1 in the botulinum-toxin group and 9 in the nitroglycerin group - crossed over to the other treatment ; the fissures subsequently healed in all 10 patients . There were no relapses during an average of about 15 months of follow-up . CONCLUSIONS Although treatment with either topical nitroglycerin or botulinum toxin is effective as an alternative to surgery for patients with chronic anal fissure , botulinum toxin is the more effective nonsurgical 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 .