Non surgical therapy for anal fissure

Non-surgical treatments for anal fissure in adults

“…A Cochrane systematic review identified 18 randomised placebo-controlled trials of topical glyceryl trinitrate (involving a total of 1,315 patients). Glyceryl trinitrate was found to be better than placebo in healing chronic anal fissure (49% vs. 36% with placebo, p < 0.0009) 5. The review also cites two case series with long follow up that reported recurrence rates in patients treated with glyceryl trinitrate of 51% and 67% 5.…”

“…paracetamol) may be helpful for people who experience prolonged pain after defaecation 2. Topical anaesthetics, such as lidocaine (off-label use), applied before defaecation might be expected to help reduce discomfort; however in trials they have been shown to be no more effective than placebo 5. In addition, they may cause skin sensitisation and so should only be used for short periods 1,2…”

“…A fissure which has not healed (perhaps because of a critical combination of poor blood supply and a high anal sphincter pressure) within an arbitrary 6 weeks is termed chronic fissure 1,3. Symptoms resulting from chronic anal fissure tend to wax and wane over time, but the majority of established fissures will require some form of intervention 5. Most anal fissures are found in the posterior midline and fewer in the anterior midline 1.…”

Anorectal bleeding: etiology, evaluation, and management (with videos)

“…61 Injection of botulinum toxin results in wound healing in about 65% of patients. 62,63 Botulinum toxin was as effective as nitroglycerin in a meta-analysis of 3 randomized studies. Also, fewer adverse effects were reported with botulinum toxin.…”

The role of endoscopy in patients with anorectal disorders

“…Surgery has been superior to medical therapy in recent studies, [60][61][62][63][64][65] with high healing and low relapse rates. Lateral internal sphincterotomy involves incising the internal anal sphincter through the skin of the lateral aspect of the anus, away from the anterior and posterior midline to reduce sphincter tone.…”