Medical Therapy for Anal Fissure: Past, Present, and Future

Medical therapy for anal fissure is designed to relax the internal anal sphincter, much as is done by sphincterotomy, but reversibly, and thus avoiding long standing minor incontinence. The effectiveness and future of this approach is assessed. Publications were sought in Medline using the search terms: anal fissure randomized, and all articles screened for inclusion. Randomized controlled trials that had at least one arm involving medical therapy for anal fissure were chosen, as were systematic Cochrane reviews of these articles and the quantitative assessment of therapeutic effectiveness reported. In addition, the newer therapies being developed are listed, most of which have not yet been subjected to randomized trials, so their effectiveness is unknown. Lastly, the major problems still facing medical therapy for anal fissure are listed in hope that trials will be conducted that will specifically address these questions. Currently medical therapy for anal fissure is effective in achieving long term cure, whether glyceryl trinitrate ointment, botulinum toxin injection, or calcium channel blockers given orally or topically, but only marginally so. They are far less effective than surgery.