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 .
Randomized, double-blind trial comparing topical nitroglycerine with xylocaine and Proctosedyl in idiopathic chronic anal fissure.
OBJECTIVE To compare symptomatic relief , healing , and changes in maximal anal resting pressure with the use of topical formulations in patients with chronic anal fissure . METHODS Sixty-four consecutive patients with chronic anal fissure were r and omized into 4 groups that received , in a double-blind manner , a topical ointment that contained 0.2 % nitroglycerine ( GTN ) , 5 % xylocaine , Proctosedyl ( hydrocortisone acetate , heparin , framycetin sulfate , esculoside , ethoform , butoform ) or petroleum jelly ( Vaseline ) , to be applied twice daily . Patients were review ed at 2-week intervals for 6 weeks . Anal manometry was done before , and 20 minutes after , the first application of the ointment . RESULTS There was significant ( p < 0.0001 ) reduction in mean anal resting pressure after application of GTN , but not any other ointment . Of 16 patients receiving GTN , complete pain relief occurred in 6 and 15 patients after 2 and 4 weeks of treatment , respectively ; this was more frequent than in the other 3 groups . At 6 weeks also , complete pain relief occurred more often with GTN than with Vaseline or xylocaine . After 4 weeks of treatment , 3 patients on GTN had complete healing of fissure as compared to one each in the xylocaine and Proctosedyl groups and none in the Vaseline group . At 6 weeks , healing of fissure had occurred in 15 of 16 patients receiving GTN as compared to 4 receiving Vaseline , 11 receiving xylocaine , and 12 on Proctosedyl . CONCLUSIONS Topical nitroglycerine produces ' chemical sphincterotomy ' with reduction in mean anal resting pressure . Pain relief and healing of fissure occurred earlier with GTN than with other treatments . GTN should be considered as the treatment of choice for the non-surgical management of patients with chronic anal fissure
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 .