ACUTE ANAL FISSURE

EFFECT OF TOPICAL GLYCERYL TRINITRATE (GTN) ON ITS MANAGEMENT

Abstract

Objective: To evaluate the role of topical glyceryl trinitrate (0.2% GTN) on the clinical features of acute anal fissure. S t u dy
design a n d setting: A prospective, open label therapeutic trial was carried out at Combined Military Hospital, Kharian Cantonment during one
calendar year. Patients a n d M e t h o d s : 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.