Treatment Of Acute Anal Fissure Research Articles

Role of Adding Topical Metronidazole in the Treatment of Acute Anal Fissure

Background: An anal fissure is a longitudinal ulcer in the anoderm of the distal anal canal which extends from the anal verge proximally towards, but not beyond, the dentate line. Anal fissure is a disease characterized by severe pain in the anorectal region with constipation, per rectal bleeding and sometime itching. Recently, anaerobic bacteria are sorted out as a causative factor. Objective: This study investigates patient compliance in the treatment of anal fissure with adding topical metronidazole. Materials and method: A total number of 100 patients attended to the General Surgery Clinic of Delta Medical College Hospital, Department of Surgery, between December 2020 and May 2021 and diagnosed with acute anal fissure were included in this prospective study. Patients older than 18 years, including non-pregnant, pregnant and lactating women are recruited. Patients were randomly divided in two groups. One group (group: 1) was treated with topical glyceryl trinitrate [0.4% nitroglycerin ointment], and the other group (group: 2) was treated with topical glyceryl trinitrate [0.4% nitroglycerin ointment] and topical antibiotic [metronidazole 0.75%]. Results: There is no difference between the groups regarding age and symptoms. From week 1, fissure healing rates were high in group 2. Group 2 VAS score levels were lower than group 1 and achieved by group 1 only in week 4. Compliance of pregnant and lactating lady was more in group 2. Conclusion: Adding topical metronidazole to treatment of acute anal fissure reduces the duration and severity of pain, shortens healing time and increases the healing rate. Delta Med Col J. Jan 2021;9(2): 84-90

Efficacy of local metronidazole with glyceryl trinitrate versus topical glyceryl trinitrate alone in the treatment of acute anal fissure: a randomized clinical trial

Introduction Anal fissure is one of the most common diseases of the anorectal region that is frequently encountered in surgical practice, equally affects both women and men. Acute anal fissures last shorter than 6 weeks. The American Society of Colon and Rectal Surgeons favors conservative management of anal fissure as the first line of treatment. A rectal ointment containing 0.2% glyceryl triturate (GTN) can be recommended to promote the healing of anal fissures and decreasing sphincter spasm. Metronidazole is a 5-nitroimidazole derivative antibiotic with a cytotoxic bactericidal effect particularly on anaerobic bacteria. The purpose of the present study was to investigate whether local metronidazole antibiotic cream is effective and safe to use in reducing the symptoms and improving the healing process of acute anal fissure. Patients and methods This study was performed in Mansoura University Hospital, surgery outpatient clinic from the period of July 2022 till July 2023. This study was a single-blinded, randomized controlled trial. Total 100 patients were included in this study and randomly divided into two groups, 50 patients in each group. First group (group 1) treated by combination of local metronidazole 10% with 0.2% GTN while the second group treated only with GTN. Results Anal pain were present in both group in all patients with acute anal fissure while constipation were 88% in group 1 and 76% group 2. To lesser extent itching, bleeding, and diarrhea were presented in both group. Visual analog scale for pain intensity were equal in both groups at the time of first clinical examination. After 1 week and 1 month of treatment there were statistically significant difference between both groups thus the visual analog scale were lower in group 1 than group 2 (0.001 and <0.001, respectively). Healing of acute anal fissure was assessed clinically at variable interval for all patients there is statistically significant difference between both group (0.004) as regard healing, first group showed earlier and faster healing and fewer number of nonhealing of the fissure at the end of follow up. Conclusion Adding local metronidazole 10% to the classic GTN treatment will improve the symptoms of acute anal fissure specially pain and discomfort and markedly accelerate healing process.

The Effect of Topical Nifedipine versus Diltiazem on the Acute Anal Fissure: A Randomized Clinical Trial.

Background: The anal fissure is one of the most common anorectal diseases that is associated with reduced quality of life and productivity loss. We aimed to compare the efficacy of topical nifedipine and diltiazem for the treatment of acute anal fissure (AAF). Methods: This single-blind randomized clinical trial was conducted at Ziaeian hospital, Tehran. Patients with an acute fissure diagnosis were allocated to two groups. Group A applied 3 grams of 0.3% nifedipine cream on the peri-anal area, three times a day, for 8 weeks. Group B also applied the same amount of 2% diltiazem-ointment on the peri-anal area for the same period. The primary outcome was fissure remission in the 8th week of the treatments. The duration of pain relief, the side effect of treatment, and the recurrence rate were also compared between the groups. Results: After 8 weeks of treatment, a remission rate of 77.4% was shown in the nifedipine group which was significantly higher than the diltiazem group with a remission rate of 54% (P=0.01). Applying nifedipine ointment is associated with earlier pain relief compared with diltiazem (P<0.001). After 6 months of follow-up, the relapse rate was not statistically different between the nifedipine and diltiazem groups (16.3% versus 21.4%, respectively). Conclusion: The application of topical nifedipine is associated with shorter pain relief and more remission rate for AAF compared with topical diltiazem. However, both methods were not different in terms of related side effects and AAF recurrence rate.

Comparative Efficacy of Topical Metronidazole and Glyceryl Trinitrate Versus Topical Glyceryl Trinitrate Alone in the Treatment of Acute Anal Fissure: A Randomized Clinical Trial.

Background and objective An anal fissureis a longitudinal, oval lesion in the anal canal. In over 90% of instances, the anal fissures are located posterior to the midline and produce discomfort upon defecation and/or bleeding owing to spasms of the internal anal sphincter that leads to ischemia. This research aimed to determine if topical metronidazole treatment when combined with glyceryl trinitrate 0.2% (GTN), is more successful than GTN alone in reducing the time for an acute anal fissure to heal. Material and methods This study was a single-blinded, randomized controlled trial conducted at the DHQ Hospital Okara from January 2022 to August 2022. Patients of both genders, aged 18 to 70 years, with acute anal fissures, were included. One hundred forty patients who satisfied the inclusion criteria were randomized through the lottery technique and were divided into two groups (70 in each group). Group A contained patients who got metronidazole combination with GTN, while in Group B, patients treated with GTN alone without metronidazole. The primary endpoint was fissure healing, confirmed as finding a scar where the fissure was. While the secondary endpoint was maximum pain on defecation assessed by the Visual Analogue Scale (VAS). Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) v24. Chi-Square and Fisher's Exact tests were done for statistical analysis, and p < 0.05 was considered significant. Results Three patients lost the follow-up. Out of the remaining 137, 70 (51.1%) patients were male. The patient's ages ranged from 22 to 68 years, with a mean age of 39.18 ± 11.52. One hundred twenty six (92%) complained of pain on defecation with a mean VAS of 6.01 ± 2.35. 80 (58.4%) patients complained of perianal itching, while 25 (18.2%) patients complained of bleeding on defecation. On week 1 follow-up, in group A out of 69 patients, 27 (39.1%) had complete healing, 38 (55.1%) had partial healing, while in group B out of 68 patients, one (1.4%) had complete healing, 43 (63.2%) had partial healing (p = < 0.001, significant). On week 3 follow-up, in group A out of 69 patients, 47 (68.1%) had complete healing, and 22 (31.8%) had partial healing, while in group B out of 68 patients, 16 (23.5%) had complete healing, 49 (72%) had partial healing (p = < 0.001, significant). Mean VAS score of group A was 0.61 ± 1.38 while that of group B was 2.57 ± 2.50 (p = < 0.001, significant). Conclusion Using topical metronidazole as an addition to standard therapy may reduce the chronicity of acute anal fissures and prevent surgical treatments with high rates of complications.

Role of local antibiotics in the treatment of acute anal fissure.

Objective: To assess the role of topical antibiotic (mertronidazole) in the treatment of acute anal fissure. Study Design: Randomized Control Trial. Setting: General Surgery Outpatient Department of Aziz Fatima Hospital. Period: January 2020 and March 2021. Material &amp; Method: In this study, patients were divided into two groups randomly. Patients in Group 1 were given only 0.2% GTN ointment and those in Group 2 were given 0.2% GTN ointment and metronidazole cream. All patients’ VAS scores for pain and healing of fissure by examining the peri anal area, as well as any adverse effects of the drugs, were recorded and statistically compared. Patients demographic characteristics, such as age and gender, were recorded. All patients were physically examined at the end of weeks 2, 4, and 6 of treatment. All statistical data analyses were performed using the Statistical Package for the Social Sciences (SPSS) version 23.0. Descriptive statistics were used for comparisons. t test, and chi-square test were used to assess independent samples. A p-value &lt;0.05 was accepted as statistically significant. Results: There were 46 (92%) female and 4 (08%) male patients in Group 1 and 48 (96%) female and 2 (24%) male patients in Group 2. The mean ages of the patients were 35.4±3.7 years in Group 1 and 37.8±4.2 years in Group 2. The mean VAS scores of the patients at the time of presentation to the hospital (pretreatment) were 7.2±1.2 in Group 1 and 7.4±0.9 in Group 2 (p=0.058). The mean VAS scores of the patients at the end of week 2 were 4.6±0.8 in Group 1 and 4.2±0.9 in Group 2 (p=0.058). The mean VAS scores of the patients at the end of week 4 were 3.2±O.7 in Group 1 and 2.4±0.8 in Group 2 (p=0.00004). The mean VAS scores of the patients at the end of week 6 were 2.36+0.65 in Group 1 and 1.86±0.48 in Group 2 (p&lt;0.00054). In Group 1, 6(12%) patients had recovery at week 4 and 26 (32%) patients at week 6 with no recovery seen in 18(36%) patients. In Group 2, 9 (18%) patients had recovery at week 2 and 33(66%) patients at week 4 with no recovery seen in 8(16%) patients. There was a statistically significant difference between these data (p=0.022). Conclusion: We have observed that topical metronidazole along with other traditional management is an fruitful, easy-to-use, safe, rapid and secure option that helps in further reducing pain associated with anal fissure and increasing the healing rate. It is also effective in preventing the anal fissure to become chronic.

Value Assessment of Local Treatment (Diltiazem Hydrochloride gel/vs Glycerile Trinitrite ointment) in acute Anal Fissure

Background: Anal fissure is a linear tear in the distal anal canal, associated with spasm of internal anal sphincter. Acute anal pain with bleeding on defecation are the main symptoms. Different types of chemical treatment to relax the sphincteric muscles have tried. Objective: Assess the efficacy, side effects and recurrence rate of 0.2% glycerile trinitrate ointment (GTN) and 2% diltiazim hydrochloride gel (DTZ) in treatment of acute anal fissure. Methods: A prospective randomized trial of 112 patient with acute anal fissure over 1.5 years period at Al-Kindy Teaching Hospital. The diagnosis was entirely clinical. Setting of inclusion and exclusion criteria, ethical consideration respected.

To Compare the Mean Postop Pain between Manual Dilatation of Anus and Lateral Internal Sphincterotomy in the Treatment of Acute Anal Fissure

Aim: To compare the mean post-operative pain between manual dilatation of anus and lateral internal sphincterotomy in the treatment of acute anal fissure. Study design: Randomized Controlled Trial Settings: Department of General Surgery, Bahawal Victoria Hospital, Bahawalpur Study duration: 4th October 2020 to 3rd April 2021. Methods: Total 88 patients with acute anal fissure, 30-70 years of age of both genders were selected. Patients with secondary hemorrhoids as a result of abdominal malignancy, anorectal deformity, hypotonic sphincter, underwent previous anorectal surgery, previous anal sphincterotomy or anal dilatation, hemorrhoids, proctitis, abscess, perianal sepsis, proctalgia fugax and fissure were excluded. In group A patients, lateral internal sphincterotomy with open technique was done. Patients in group B were undergone manual dilatation of anus under general anesthesia. Results: The mean age of women in group A was 46.73±8.58 years and in group B was 46.86±10.26 years. Majority of the patients 65 (73.86%) were between 25 to 40 years of age. Out of 88 patients, 60 (61.18%) were males and 28 (38.88%) were females with male to female ratio of 2.1:1. In my study, mean postoperative pain after 10th day was 0.80 ± 0.73 after lateral internal sphincterotomy vs 2.20 ±0.85 after manual dilatation of anus with p-value of 0.0001. Conclusion: This study concluded that the postoperative pain after lateral internal sphincterotomy is less as compared to manual dilatation of anus in the treatment of acute anal fissure. Keywords: Acute anal fissure, lateral internal sphincterotomy, manual dilatation of anus.

To Compare the Mean Postoperative Pain between Manual Dilatation of Anus and Lateral Internal Sphincterotomy

Aim: To compare the mean post-operative pain between manual dilatation of anus and lateral internal sphincterotomy in the treatment of acute anal fissure. Study design: Randomized Controlled Trial Settings: Department of General Surgery, Bahawal Victoria Hospital, Bahawalpur Study duration: 4th October 2020 to 3rd April 2021. Methods: Total 88 patients with acute anal fissure, 30-70 years of age of both genders were selected. Patients with secondary hemorrhoids as a result of abdominal malignancy, anorectal deformity, hypotonic sphincter, underwent previous anorectal surgery, previous anal sphincterotomy or anal dilatation, hemorrhoids, proctitis, abscess, perianal sepsis, proctalgia fugax and fissure were excluded. In group A patients, lateral internal sphincterotomy with open technique was done. Patients in group B were undergone manual dilatation of anus under general anesthesia. Results: The mean age of women in group A was 46.73±8.58 years and in group B was 46.86±10.26 years. Majority of the patients 65(73.86%) were between 25to 40 years of age. Out of 88 patients, 60(61.18%) were males and 28 (38.88%) were females with male to female ratio of 2.1:1. In my study, mean postoperative pain after 10th day was 0.80±0.73 after lateral internal sphincterotomy vs 2.20 ±0.85 after manual dilatation of anus with p-value of 0.0001. Conclusion: This study concluded that the postoperative pain after lateral internal sphincterotomy is less as compared to manual dilatation of anus in the treatment of acute anal fissure. Keywords: Acute anal fissure, lateral internal sphincterotomy, manual dilatation of anus.

The importance of topical metronidazole in the treatment of acute anal fissure: a double-blind study controlled for prospective randomization.

Acute anal fissure, a disease characterized by severe pain in the anorectal area, reduces quality of life and becomes chronic absent appropriate treatment. More recently, anaerobic infections have been noted as contributive to etiopathogenesis. This study investigates topical metronidazole's effect in the treatment of acute anal fissure. Our prospective randomized controlled double-blind study included 2 groups of 100 patients older than 18 years from our General Surgery Clinic with anal fissure complaints for less than 8 weeks. Topical diltiazem treatment was started in group 1, and topical diltiazem and metronidazole treatment in group 2. Pain levels were evaluated by the visual analogue scale (VAS) score, and recovery status was evaluated by physical examination findings ab initio and at the 1st, 4th, and 6th weeks. VAS score levels, demographic, clinical, and recovery status were then compared. There was no difference between the groups as to age, sex, pain on defecation, bleeding, constipation, and duration of pain, bleeding and constipation (P>0.05). From week 1, fissure epithelialization and healing rates were higher in group 2 (P<0.001); group 2 VAS score levels were lower than in group 1 (P<0.001) and achieved by group 1 only in week 4 (P=0.073). Adding topical metronidazole to treatment reduces the duration and severity of pain, shortens healing time, and increases the healing rate.

Comparative Study between the Use of Topical GlycerylTrinitrate Vs. Topical Diltiazem in Treatment of Acute Anal Fissure

AbstractBackground: Acute anal fissure is a painful conditioncommonly results due to an increase in internal anal sphincterpressure. It is a painful condition which leads to significantmorbidity mostly in young adults. It is a split in the mucosaof the distal anal canal that can progress to form a chroniclinear ulcer. The common symptoms are severe pain on orafter defecation and bleeding per anus.Aim of Study: The main aim of this study is to evaluatethe efficacy and adverse effects of topical 2% Diltiazem (Calcium channel blocker) and topical 0.2% Glyceryl trinitrate (GTN), when administered as single agents in the treatmentof acute anal fissure.Patients and Methods: 40 Patients with acute anal fissurewere enrolled in the study. They were randomized using aclosed envelop technique into two group (20 patients each):Group A (2% Diltiazem users), and Group B (0.2% Glyceryltrinitrate users). Pain was evaluated using a pain Visual AnalogScale (VAS), we also evaluated the anal bleeding, constipation,perianal itching (anal pruritus) before, during and after thetopical medications are used, and the results of each topicalmedications as healing, recurrence rates, onset of relief ofsymptoms, onset required to achieve complete healing, numberand severity of side effects as (headache, postural hypotension,flushing, allergy, GIT upset) or ineffectiveness.Results: Both 0.2% glyceryl trinitrate ointment and 2%diltiazem ointment are equally effective concerning pain relief,and recurrence rates, while higher healing rates with topicalDiltiazem (DTZ) than topical Glyceryl Trinitrate (GTN) wererecorded (85% compared to 75% respectively). However,headache is a troublesome side effect with topical glyceryltrinitrate. Accordingly, topical 2% diltiazem is preferable asthe treatment of choice for acute anal fissure.Conclusion: Although surgical management like analdilatation and open or closed sphincterotomy are a one-timesolution with good symptomatic relief, it may be complicated by complications of wound healing, and permanent incontinence of flatus or faeces. The preferable treatment of acute anal fissure is becoming more medical since it is cost-effective. Both 0.2% glyceryl trinitrate ointment and 2% diltiazem ointment are equally effective in concerning pain relief, healing and recurrence rates. However, headache is a troublesome side effect in patients treated with topical glyceryl trinitrate.Therefore, when considering medical management for treatingacute anal fissure, topical 2% diltiazem is the treatment ofchoice.

MEBO versus topical Diltiazem versus a combination of both ointments in the treatment of acute anal fissure: a randomized clinical trial protocol

BackgroundAnal fissure is a common complication of the anorectal region and one of the most reported causes of anal pain. Acute anal fissure can be cured by surgery or medical treatment. There is an increase in the use of topical therapy for the treatment of anal fissures. A common topical drug used is Diltiazem (DTZ), a calcium-channel blocker, which relaxes the anal sphincter and thus promotes healing of the anal fissure. Moist exposed burn ointment (MEBO) is an ointment that is effective for the treatment of burns and wound healing and is becoming popular in the treatment of anal fissures.MethodsThis is a 1:1:1 randomized, controlled, parallel design, with endpoint measures of change in pain score, wound healing, defecation strain score and patient’s global impression of improvement. The study will be conducted at AUBMC over a 10-week period. Patients will be randomized to three treatment arms: MEBO, Diltiazem, and a combination of MEBO and Diltiazem ointments.DiscussionThe results of this study will allow physicians to assess the efficacy and safety of MEBO in the treatment of acute anal fissure, and also in comparison to Diltiazem. This trial will generate evidence-based conclusions regarding the use of a herbal/natural-based product (MEBO ointment) for the treatment of anal fissures.Trial registrationClinicalTrials.gov Identifier NCT04153032. Clinical Trial Registration Date: 06-NOVEMBER-2019.

Topical Lignocaine with Diltiazem or Glyceryltrinitrate for Paediatric Acute Anal Fissure: A Randomized Clinical Trial

Introduction: Anal fissure is a common problem in children, the exact etiology of which is unknown and it mostly presents with painful defecation and bleeding per rectum. The standard treatment of anal fissure is lateral internal sphincterotomy but due to risk of fecal incontinence chemical sphincterotomy is used as alternative to surgical sphincterotomy. Aims &amp; Objectives: To compare the effectiveness of topical diltiazem and lignocaine with glyceryl trinitrate and lignocaine in relieving of symptoms and healing of acute anal fissure in children. Place and duration of study: This study was conducted in the Department of Paediatric Surgery, Shaikh Zayed Hospital, Lahore &amp; Department of Paediatric Surgery, Fatima Memorial Hospital, Lahore from September 2017 to September 2018. Material &amp; Methods: Total 228 children were enrolled in the study and randomly divided in group A and B, 114 children in each group. Group A received topical 2% diltiazem cream and 2% lignocaine gel, while group B received topical 0.2% glyceryl trinitrate and 2% lignocaine gel, applied locally, twice daily. Results: There were 78(68.4%) male children in group A and 66(57.9%) in group B. All patients completed 6 week treatment course. The symptoms and condition of the anal fissure were evaluated before start of treatment and at subsequent follow up periods. In group A 55 (48.2%) cases completely healed by second week, while in group B, 33 (28.9%) cases healed. The number of completely healed cases at 4 weeks follow up in group A and group B were 91 (79.8%) and 69(60.5%) respectively, while at week 6 follow up this rate was 95 (83.3%) and 73 (64.0%) respectively. Symptomatic relief in painful defecation observed in group A and group B was 74(64.9%) and 55(48.2%) at week 2, 95(83.3%) and 74(64.9%) at week 4 while 95(83.3%) and 77(67.5%) at week 6 in two groups respectively. Conclusion: Use of combination of topical diltiazem and lignocaine for the treatment of acute anal fissure in paediatric population is preferred over combination of glyceryl trinitrate and lignocaine.

Botulinum toxin versus other therapies for treatment of chronic anal fissure

Anal fissure is the most frequent of proctological pathology after hemorrhoids. The hypertonicity of the internal sphincter and the hypovascularization of the posterior pole of the anus play a central role in its pathophysiology. Treatment aims to reduce the hypertonicity of the internal sphincter, thus eliminating pain, allowing healing, and avoiding recurrence. Treatment of acute anal fissure is essentially medical; treatment of chronic anal fissure resistant to therapy is surgical. The reference surgical treatments are lateral internal sphincterotomy (LIS), regardless of its risk for flatus incontinence, and posterior sphincterotomy with anoplasty. Conservative approaches such as topical application of ointment or botulinum toxin injections have been proposed in order to treat this condition without any risk of permanent injury to the internal anal sphincter. These treatments are effective in a large number of patients. Furthermore, with the availability of medical therapies to induce healing of anal fissure, the risk of a first-line surgical approach is difficult to justify. The conservative treatments have a lower cost than surgery. This paper reports the most recent findings on conservative treatment of chronic anal fissure.

Erysimum cheiri and Rosa × damascena cerate vs. Diltiazem 2% gel in the treatment of acute anal fissure: A randomized, controlled clinical trial

IntroductionAnal fissure which is an ischemic ulcer in the lining of the anus, is a common challenging problem in current medicine. This study was designed to evaluate the benefits of a Persian Medicine cerate containing wallflower (Erysimum cheiri) and damask rose (Rosa×damascena) oil (WDC) on anal fissure. MethodsThis randomized, controlled clinical trial was conducted on 64 acute anal fissure patients. In each group, patients were given either 0.5 g of WDC or 2.5 cm of Diltiazem 2% gel twice daily for 2 weeks. Anal pain, itching and inflammation were primary outcomes. The recurrence rate and statistical analyses were performed on a per protocol and intention-to-treat basis. ResultsFifty-three patients completed the study. The symptoms decreased significantly (p < 0.05) in all patients after 2 weeks. Comparison of responses between groups reveals no significant differences (p > 0.05) in pain, itching, and inflammation. There was no significant difference (p > 0.05) in recurrence rate of the disease, but the trend of healing in WDC group was better than Diltiazem 2% gel after six weeks. No serious adverse events were observed. ConclusionThe results suggest that topical application of the cerate containing wallflower and damask rose oil can be considered as a potential herbal medicine for the treatment of anal fissure. It exerts comparable clinical effects to current routine treatment. Further studies with long-term follow-ups and larger sample sizes are necessary to have a comprehensive overview of the safety and efficacy of this natural preparation.

Comparative Evaluation of MEBO Ointment and Topical Diltiazem Ointment in the Treatment of Acute Anal Fissure

Comparative Evaluation of MEBO Ointment and Topical Diltiazem Ointment in the Treatment of Acute Anal Fissure

Comparative study of manual anal dilatation and lateral internal anal sphincterotomy in the treatment of acute anal fissure

Background: An anal fissure is an extremely common condition which is also one of the most painful condition. It can be very troubling because, if acute, the severity of patient discomfort and extent of disability far exceed that which would be expected from a seemingly trivial lesion. This study compares two most commonly done procedures for anal fissure, manual anal dilatation (MAD) and lateral internal anal sphincterotomy (LAS).Methods: This is a prospective cohort study comparing MAD and LAS in the treatment of chronic anal fissure at Sri Venkateswara Medical College, Tirupati, from December 2017 to December 2018. A total of 60 patients who met inclusion criteria were randomized to undergo either MAD or LAS and analyzed for post-operative pain, post-operative complications, hospital stay, recurrence rates and compliance.Results: Total 60 patients were randomized to MAD and LAS. The patients who have undergone LAS have better pain relief and slightly increased risk of infection. Those who have undergone MAD have less risk of infection and recurrence rates and complications are not significantly less than LAS.Conclusions:MAD and LAS are both equally effective and safe for treatment of acute anal fissure with less chances of recurrence. However postoperative pain was slightly more in MAD group.

Could local antibiotics be included in the treatment of acute anal fissure?

Acute anal fissure is a very common disorder of the anorectal region. Its most widely used treatment method is the medications given in addition to conservative therapies. The objective of the present study was to investigate the effects of local metronidazole use in the treatment of acute anal fissure on the symptoms and remission processes of the patients. This was a prospective, randomized, controlled clinical study conducted on 100 consecutive patients who presented to our clinic between March 2016 and March 2017 and who were diagnosed with acute anal fissure. Patients were randomly divided into two groups of 50 persons. Patients in Group 1 were given only 5% lidocaine pomade as a local anesthesia, and those in Group 2 were given 5% lidocaine pomade and metronidazole cream. Patients applied the medications topically to the anal margin 3 times per day for 4 weeks. Patients' demographic characteristics, such as age and gender, were recorded. All patients were invited for check-up at the end of weeks 1, 2, and 4 of treatment. The Visual Analogue Scale scores for pain and the healing status of their fissure by visual inspection, as well as any adverse effects of the drugs, were recorded. The results were compared statistically. A p-value <0.05 was considered significant. The mean ages of the patients were 34.2±4.1 years in Group 1 and 36.6±3.8 years in Group 2. As a result of the statistical comparison of the Visual Analogue Scale scores, there was a statistically significant difference between the two groups at the end of weeks 2 and 4 (p=0.004 and p<0.001, respectively). In Group 1, 28 (56%) patients recovered, but no recovery was observed in 22 (44%) patients. In Group 2, 43 (86%) patients recovered, whereas 7 (14%) patients had no recovery (p=0.004). The topical antimicrobial treatment with metronidazole as an addition to the classical medical treatments in acute anal fissure is an effective and safe practice resulting in further reduction in pain and increased healing rate.

Anal self-massage in the treatment of acute anal fissure: a randomized prospective study.

BackgroundAn anal fissure (AF) is a tear in the epithelial lining of the anal canal. This is a very common condition, but the choice of treatment is unclear. The use of anal dilators is effective, economic, and safe. The aim of the study was to compare the efficacy of two conservative treatments, the use of anal dilators or a finger for anal dilatation, in reducing anal pressure and resolving anal fissures.MethodsFifty patients with a clinical diagnosis of AF were randomly assigned to one of the treatments, self-massage of the anal sphincter (group A, 25 patients) or passive dilatation using dilators (group B, 25 patients). All patients were evaluated at baseline, at the end of treatment, and after 12 weeks and 6 months. Pain was measured using a visual analog scale.ResultsAfter the treatment, 60% of patients treated with dilators and 80% of patients treated with anal self-massage using a finger showed disappearance of their anal fissures. A comparison between signs and symptoms reported by the patients in the two groups showed a statistically significant reduction in anal pain (group A, P=0.0001; group B, P=0.0001) and bleeding after defecation (group A, P=0.001, group B, P=0.001). At 6 months after treatment, a significantly greater reduction in anal pain was observed in Group A compared to Group B (P=0.02).ConclusionThe use of anal self-massage with a finger appears to induce a better resolution of acute anal fissure than do anal dilators, and in a shorter time.

Efficacy of egg yolk and nitroglycerin ointment as treatments for acute anal fissures: A randomized clinical trial study.

BackgroundAcute anal fissure as a common disease in society has several etiologies and manifestations such as severe anal pain and bleeding. Nitroglycerin ointment 0.2% is the most common topical treatment used. The most common side effect of nitroglycerin is headache, which is annoying for patients and often leads to discontinuation of the drug.ObjectiveComparison of egg yolk as a natural substance with analgesic and anti-inflammatory properties and minimal side effects with nitroglycerin ointment in the treatment of acute anal fissure.MethodsThis randomized clinical trial was carried out during a 10-day period in the Gastroenterology clinic of Ghaem Hospital, Mashhad, Iran (year 2015). 126 patients who filled the inclusion criteria were enrolled. The patients were randomly divided into two groups. Nitroglycerin ointment (0.2%) was applied by patients in the first group, twice daily for 10 days. For the second group, one egg yolk once a day was administered rectally up to 10 days. The pain and bleeding severity were recorded every two days up to 10 days after finishing the treatment course, based on visual scaleResultsThe results showed that egg yolk caused a significant reduction in pain and bleeding compared with nitroglycerin (p<0.05). At the beginning of the study, the difference in pain intensity between the two groups was not statistically significant (p-value = 0.25). However, it became significant in the following days. Changes in the frequency of rectorrhagia were also significant in both groups, showing a major decrease in the number of rectorrhagia cases (p<0.001).ConclusionEgg yolk is more efficient than nitroglycerin in the treatment of acute anal fissure. In addition, lack of any side effects results in the completion of the treatment course by the patients.Trial RegistrationThe trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2015050718915N3.FundingThis work was supported by a grant from the Vice Chancellor of Research of Mashhad University of Medical Sciences.

Efficacy of lanolin and bovine type I collagen in the treatment of childhood anal fissures: A prospective, randomized, controlled clinical trial

We designed an open-labeled, prospective, randomized, controlled clinical trial to test the efficacy of topical lanolin ointment (PureLan) and bovine type I collagen spray (Gelfix) in the treatment of childhood anal fissures. Seventy-one children with acute anal fissure were divided randomly into three groups: group I (control; n = 25), group II (PureLan; n = 28), and group III (Gelfix; n = 18). All children were assigned to have warm sitz baths, topical analgesic creams, and stool softeners. Patients in groups II and III were also treated with topical lanolin ointment and bovine type I collagen, respectively. All children were re-examined 4 weeks later. Complete healing of the anal fissure was observed in 68% of the group I patients, but in 92.9% and 100% of the group II and III patients, respectively. The difference among groups was significant in terms of complete fissure healing (P = 0.003), but the efficacy of topical lanolin ointment and bovine type I collagen spray did not differ significantly (P = 0.078). Our data suggest that topical lanolin ointment and bovine type I collagen spray are effective in the treatment of acute anal fissure in children.