الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 143 |  |  |
| | | from | 143 | | |
Abstract
Background: Acute anal fissure is a painful condition commonly results due to an increase in internal anal sphincter pressure. It is a painful condition which leads to significant morbidity mostly in young adults. It is a split in the mucosa of the distal anal canal that can progress to form a chronic linear ulcer. The common symptoms are severe pain on or after defecation and bleeding per anus.
Objectives: The main aim of this study is to evaluate the 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 treatment of acute anal fissure.
Patients and Methods: 40 Patients with acute anal fissure were enrolled in the study. They were randomized using a closed envelop technique into two group (20 patients each) : group A (2% Diltiazem users), and group B (0.2% Glyceryl trinitrate users). pain was evaluated using a pain visual analog scale (VAS), we also evaluated the anal bleeding, constipation, perianal itching (anal pruritus) before, during and after the topical medications are used, and the results of each topical medications as healing, recurrence rates, onset of relief of symptoms, onset required to achieve complete healing, number and 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 topical Diltiazem (DTZ) than topical glyceryl trinitrate (GTN) were recorded (85% compared to 75% respectively). However, headache is a troublesome side effect with topical glyceryl trinitrate. Accordingly, topical 2% diltiazem is preferable as the treatment of choice for acute anal fissure.
Conclusion: Although surgical management like anal dilatation and open or closed sphincterotomy are a one-time solution 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 treating acute anal fissure, topical 2% diltiazem is the treatment of choice.