Anal fissure: diagnosis, management, and referral in primary care

Newman, Matthew; Collie, Mhairi

doi:10.3399/bjgp19x704957

Cited by 26 publications

(20 citation statements)

References 4 publications

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“…It has been demonstrated that topical anaesthetics, such as lidocaine 5% ointment, are beneficial for short-term usage. A rectal ointment containing 0.2% or 0.4% glyceryl trinitrate (GTN) can be recommended to promote the healing of anal fissures [7].…”

Section: Introductionmentioning

confidence: 99%

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

Shahid¹,

Javed²,

Javed³

et al. 2022

Cureus

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Background and objectiveAn anal fissure is 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 methodsThis 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. ResultsThree 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). ConclusionUsing 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.

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Section: Introductionmentioning

confidence: 99%

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

Shahid¹,

Javed²,

Javed³

et al. 2022

Cureus

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“…Newman et al observed 23% similar GTN side effects. (27) In 3% of group II during the first week of the research, gas and liquid incontinence disappeared without intervention after 4 weeks. It echoed Alvandipour et al (28).…”

Section: Discussionmentioning

confidence: 93%

Early Lateral Internal Sphincterotomy Versus Conservative Treatment; Our Experience in Treatment of Chronic Anal Fissure in Qazi Hussain Ahmed Medical Complex Nowshera Pakistan

Ghani¹,

Khan²,

Ahmed³

et al. 2022

PJMHS

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Background: A chronic anal fissure is a longitudinal tear in the anorectal area beneath the dentate line contributing to chronic pain and emotional stress during defecation. The present study aimed to assess early surgery versus conservative treatment for managing chronic anal fissures. Methodology: This randomized control trial was carried out on 150 chronic anal fissures patients at the Department of General Surgery, Qazi Hussain Ahmed Medical Complex, Nowshera, Pakistan from March 2020 to September 2021. Patients were divided into two groups; Group-I comprised of patients who were treated conservatively and Group II consisted of patients who underwent surgical intervention. Patients above 15 years of age and fit for surgery were enrolled. A Chi-square test was used for correlating the results using SPSS version 24. Results: Of the total patients, there were 132 (88%) male and 18 (12%) female patients. The overall mean age of Group-I and Group-II was 38.7± 6.5 years and 39.6±3.67 years. The prevalence of posterior and anterior located fissures were 136 (90.7%) and 14 (9.3%) respectively. About 86 patients underwent closed LIS, out of which 77 were male and 9 were female. The patient’s main complaints were anal pain followed by bleeding. The response rate to pain relief treatments was 79% in group-I, I, and I and 97% in group II. Conclusion: Our study found that lateral internal sphincterotomy remains the gold standard for the treatment of chronic anal fissures. To avoid recurrence and obtain the best pain relief, LIS remains the gold standard for the treatment of chronic anal fissures. Keywords: Chronic anal fissure, Conservative treatment, surgical intervention

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“…20 Newman et al also reported that topical diltiazem hydrochloride (2%) or topical nifedipine (0.2-0.5%) both proved to be effective alternatives with less side effects when compared with GTN. 25 Bansal et al reported that 2% Diltiazem ointment and .02% GTN in the treatment of chronic anal fissure, were equally effective in relieving pain, healing and recurrence, but patients treated with GTN ointment had headache. So 2% Diltiazem ointment may be preferred in the medical management of chronic anal fissure as first line of treatment.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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 & 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 & Department of Paediatric Surgery, Fatima Memorial Hospital, Lahore from September 2017 to September 2018. Material & 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.

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Anal fissure: diagnosis, management, and referral in primary care

Cited by 26 publications

References 4 publications

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

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

Early Lateral Internal Sphincterotomy Versus Conservative Treatment; Our Experience in Treatment of Chronic Anal Fissure in Qazi Hussain Ahmed Medical Complex Nowshera Pakistan

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

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