الفهرس 
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Abstract
Anal fissure is a linear or elliptical tear of the anoderm, distal to the dentate line, generally located in the posterior midline. Fissures can be classified as acute or chronic.
Most anal fissures can be traced to the passage of a large hard stool, trauma to anus, or tearing during delivery. Characteristic symptoms include tearing pain during defecation which may last for several hours after bowel evacuation, and rectal bleeding (usually described as bright red blood streaking stool). On clinical examination, the fissure can often be seen in the anoderm by gently separating the buttocks.
Treatment focuses on breaking the cycle of pain, spasm, and ischemia thought to be responsible for development of chronic anal fissure.
At first, conservative measures are tried to minimize anal trauma, including bulk laxatives, stool softeners, warm sitz baths and chemical sphincterotomy. Conservative treatment is effective in most acute fissures.
Medical therapy of chronic anal fissure can also be done by medical relaxation of the internal anal sphincter, which has the advantage of being reversible and non invasive as glyceryl trinitrate (GTN), diltiazem, nifedipine and botulinum toxin.
Surgical therapy has traditionally been recommended for chronic fissures that have failed or recurred after medical therapy, and lateral internal sphincterotomy is the procedure of choice for most surgeons. The aim of this procedure is to decrease the anal tone and the spasm of the internal sphincter by dividing a portion of it. Recurrence occurs in less than 10% of patients and the risk of incontinence is not uncommon.
In this study, 60 patients suffered from chronic anal fissure were divided into two groups, each group consisted of 30 patients. DTZ group treated by topical diltiazem 2%, while GTN group treated by topical glyceryl trinitrate 0.2%.
Both groups were compared with each other as regard anal pain, healing, side effects and recurrence.
This study showed that topical diltiazem 2% application had led to pain relief ranged from 0-7 with a mean of 1.50 ± 2.56 using the visual analogue scale (VAS) after 6 weeks of treatment, healing in 73.3%, side effects in the form of headache in 6.6% and perianal itching in 26.7%, and recurrence in 13.3% after 24 weeks from the start of the treatment.
This study showed also that topical GTN 0.2% application had led to pain relief ranged from 0-7 with a mean of 1.73 ± 2.72 using the visual analogue scale (VAS) after 6 weeks of treatment, healing in 70%, side effects in the form of headache in 26.6% and perianal itching in 33.3%, and recurrence in 16.7% after 24 weeks from the start of the treatment.
This study showed as previously noted that both diltiazem ointment (2%) & glyceryl trinitrate ointment (0.2%) are quite effective in the treatment of chronic anal fissure. However, topical diltiazem had the advantage of causing fewer side effects, where headache was significantly lower with diltiazem than GTN.