Non surgical therapy for anal fissure
15 Feb 2012
Anal fissure medical treatments are searched for in place of surgery because of the risk of incontinence and the disability associated with anal fissure surgery. Pharmacologic methods that relax the smooth muscle are now being used to reverse what occurs in surgery and to obtain fissure healing. This intervention review assessed the efficacy and morbidity of various medical therapies for anal fissure. It included randomized, non-surgical anal fissure studies from 1966 to August 2010 where they abstracted data. Results showed that topical glyceryl trinitrate, botulinum toxin injection or topical calcium channel blockers nifedipine or diltiazem are marginally better than placebo. All medical therapies are far less effective than surgery for chronic fissure in adults. Some newer agents such as clove oil, sildenafil, and a "healer cream" show potential, but lack comparison to more established medications.