Randomised Prospective Controlled Trial of Topical 2 % Diltiazem Versus Lateral Internal Sphincterotomy for the Treatment of Chronic Fissure in Ano

Abstract

Fissure in ano is a very common disorder of the anorectal region. Internal sphincter hypertonia with decreased relaxation coupled with mucosal ischemia of posterior anal canal are the major pathologies in chronic anal fissure (CAF). Though lateral internal sphincterotomy (LIS) remains the gold standard of treatment for the disease, it is accompanied by the potential complication of incontinence to both flatus and faecal matter. The aim of our study was to explore the role of topical diltiazem as an effective and a safe alternative to sphincterotomy for chronic anal fissure. Ninety patients with CAF were randomly assigned to group A and group B, with 45 patients each. Group A patients received 2 % diltiazem topical application, twice daily, and group B patients underwent LIS. All the patients were reviewed at first, fourth and sixth week after initiation of treatment. Visual analogue scores for pain and healing of fissure by visual inspection were recorded and compared. In group A, 71 % had complete healing of fissure at 6 weeks, with fair amount of pain relief (mean VAS-3.38), and in group B, 96 % showed healing of fissure, with excellent pain relief (mean VAS-1.87). Headache and flushing were noted in two patients in group A while no patients in group B developed incontinence. We conclude that LIS is more effective than topical diltiazem in the treatment of CAF. Topical diltiazem may be employed as an initial conservative treatment option before considering the surgical alternative.

Pharmacodynamic evaluation of Lys5, MeLeu9, Nle10-NKA(4–10) prokinetic effects on bladder and colon activity in acute spinal cord transected and spinally intact rats

“…Similar to the urethra, the NK 2 receptors are likely present in the internal anal sphincter (Tichenor et al 2002), where their activation may keep the sphincter tight, thus providing resistance to defecation. Future studies would need to investigate the role of these receptors in decreasing defecation efficiency and whether sphincter relaxants (such as phosphodiesterase inhibitors, topical diltiazem, a calcium channel blocker, botulinum toxin A injection and other) would provide additional benefits (Ballester et al 2007; Gandomkar et al 2015; Jones et al 2002; Vaithianathan and Panneerselvam 2015). While we did not assess defecation in this study, pilot studies in chronic SCI rats showed that LMN-NKA reliably induces defecation (in progress L. Marson), suggesting that if stools were present in the rectum, both urine and stools would be excreted (sitting on a toilet to urinate would be advisable).…”

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

“…Anal fissure is one of the most common diseases of the anorectal region that is frequently encountered in surgical practice (1). It is a longitudinal rupture of the stratified squamous epithelial tissue formed in the anoderm distal to the dentate line and is generally located on the middle line posterior to the anus (2,3).…”

A comparative study of the results of the lateral internal anal sphincterotomy vs manual dilatation of anus for chronic anal fissure.

“…one study showed favorable results in manual dilatation of anus as in our study 14 but vaithiancithan reported one patients with this complications. 15 In our study we did not faced fecal incontinence in manual dilatation of anus.…”