Nitroglycerin—is it good for more than hearts?: Bacher H, Mischinger H-J, Werkgartner G, et al.Local Nitroglycerin for Treatment of Anal Fissures: An Alternative to Lateral Sphincterotomy Dis Colon Rectum 1997;40:840–5

Abstract

Nitric oxide is an important neurotransmitter mediating internal and sphincter relaxation. In a prospective, randomized study, the authors treated 35 patients with acute and chronic anal fissures using topical application to the anus and into the anal canal three times daily. Group A included 20 patients with a clinical diagnosis of acute (12 patients) and chronic (eight patients) anal fissures who received nitroglycerin (0.2% glyceryl trinitrate ointment). Group B consisted of 15 patients (10 acute and five chronic fissures) who received anesthetic gel (lignocaine). Manometry was performed before and on days 14 and 28 in the course of therapy. In 60% of Group A cases, 11 acute (91.6%) and one chronic (12.5%) anal fissures healed within 14 days. In contrast, among Group B, no healing was observed. The healing rate after one month was 80% (11 acute and five chronic) in Group A, which was superior to a 40% healing rate in Group B (five acute and one chronic). At manometry, maximum resting pressures decreased from a mean of 110 to 87 cm H 2O, and squeeze pressures decreased from 177.8 to 157.9 cm H 2O. Except for mild headaches (20%), no side effects were reported. The authors conclude that topical application of nitroglycerin represents a new, easily handled, and effective alternative for treatment of anal fissures.