Mohammad Riaz Akhtar, Habib Ullah Khan.
Acute anal fissure.
Professional Med J Jan ;16(3):332-5.

Objective: To evaluate the role of topical glyceryl trinitrate (0.2% GTN) on the clinical features of acute anal fissure. Study design and setting: A prospective, open label therapeutic trial was carried out at Combined Military Hospital, Kharian Cantonment during one calendar year. Patients and Methods: All adult males and females presenting with acute anal fissure were included. Patients with chronic anal fissure, associated pathology (hemorrhoids, fistula in ano), age < 15 years, previous surgery of anal canal were excluded. The diagnosis was based upon history and physical examination. A detailed history was taken regarding their symptoms like painful defecation, bleeding per rectum, constipation and itching. Then the patients were examined to look for anal fissure, associated mucus discharge and sphincter tone and recorded in the proforma. 0.2% topical GTN ointment was prescribed twice daily for local application in the anal canal with the help of cotton pledget on a stick (soaked completely in ointment). The duration of treatment was four weeks and their symptomatology and healing of anal fissure was assessed weekly. Results: A total of 40 patients were treated in this study. Age varied between 22 - 51 years. 36 patients (90%) were male while only 4 patients (10%) were females. Painful defecation (100%), bleeding PR (87.5%), constipation (50%), and itching (40%) were the main complaints. Posterior fissure was seen in 85%, anterior fissure in 12.5%, while both anterior and posterior fissures were seen in 2.5% of patients. Out of 40 patients 21 had complete healing of anal fissure while 03 patients recovered partially. Thus the healing rate was 60%.Conclusion: Topical glyceryl trinitrate is an effective treatment modality for acute anal fissure.

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