EFFICACY OF NIFEDIPINE, GLYCERYL TRINITRATE AND BOTULINUM TOXIN IN TREATMENT OF CHRONIC ANAL FISSURE

Abstract

Although the recommended treatments of chronic anal fissure are anal dilatation and lateral internal sphincterotomy, which are successful in 85-90% of patients, these procedures permanently weaken the sphincter, which may be associated with incontinence, infection, and anal deformity. The aim of that study is to investigate the efficacy of alternative treatment methods such as nifedipine, glyceryl Seventy-five consecutive patients who applied to Department of Surgery with the diagnosis of chronic anal fissure between 1998 and 2000 were included in the study. Patients were divided into nifedipine(n=25), glyceryl trinitrate (n=25), and botulinum toxin (n=25) groups in a prospective randomised manner. Oral nifedipine 20mg daily for five days in nifedipine group, topical 0.2% glyceryl trinitrate ointment twice daily for 30 days in glyceryl trinitrate group, and a single injection of 25 unit botulinum toxin to internal anal sphincter in botulinum group were applied. The patient in each group were evaluated for their anal resting and squeeze pressures just before and 30 days after treatment, and for their physical signs and symptoms just before and 15 and 30 days after treatment. The resting anal pressures in all treatment groups were decreased significantly according to pre-treatment results (p<0.05). Patients' signs and symptoms were also diminished or disappeared significantly in all treatment groups. No major complication due to applications was detected. It is concluded that oral nifedipine, topical glyceryl trinitrate, and botulinum toxin injection may be alternative to surgical treatment and may diminish permanent complications due to surgical management.