Glyceryl Trinitrate Treatment in Chronic Fissure in Ano

Abstract

ABSTRACT
Background: Use of glyceryl trinitrate ointment as a pharmacological manipulation of anal
sphincter tone as an alternative modality to surgery for the treatment of chronic anal
fissures.
Objectives: To evaluate the influence of topical application of 0.2% glyceryl trinitrate
ointment on healing of the chronic fissure-in-ano.
Methods: This is an interventional study on 68 patients which was studied at Al-Yarmouk
Teaching Hospital with chronic anal fissure from the period January the 1st 2014 to
December the 31st 2014. All patients were treated for a maximum period of 12 weeks with
0.2% glyceryl trinitrate ointment.
Results: Sixty eight patients were studied, 36 males (52.94%) and 32 females (47.06%)
and male to female ratio was1.12:1. The age ranged from 11 to 80 years, with a mean age
of 30 (+5) years, the majority being in the 5th decade of life constituting 25 patients
(36.7%). Also, the present study showed that the causes of the fissure-in-ano were
chronic constipation and passing hard stool 40 patients (58.83%), the next was post
haemorrhoidectomy 19 patients (27.94%), followed by post traumatic (post delivery) four
patients (5.88%), diarrhea three patients (4.41%) and anal sexual intercourse two
patients (2.94%). Within seven days, the fissure related pain was resolved in all patients.
At six weeks the anal fissure was completely healed in 28 patients (41.17%) and at nine
weeks another 26 patients (38.23%), and at 12 weeks the anal fissure was completely
healed in another 10 patients (14.71%). Four patients (5.89%) developed perianal
abscess so that lateral sphinecterotomy with excision of the skin tag and drainage of
abscess were done to them under general anesthesia.
Conclusion: Relaxation of the internal anal sphincter by topical glyceryl trinitrate probably
permits sufficient resumption of the microcirculation at the fissure site, which subsequently
promotes fissure healing. The fissure healing itself requires more time varying between six
and 12 weeks. Glyceryl trinitrate is an affordable drug and the only side effect reported is
mild transient headache. Based on the results of this study we consider local application
of glyceryl trinitrate is a viable and attractive alternative for most patients with chronic anal
fissure.
Keywords: Anal fissure, Glyceryl trinitrate, Nitric oxide.