To evaluate the
role of topical
glyceryl trinitrate [0.2% GTN] on the clinical features of acute
anal fissure. A prospective, open label
therapeutic trial was carried out at Combined
Military Hospital, Kharian Cantonment during one calendar year. 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. 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%. Topical
glyceryl trinitrate is an effective
treatment modality for acute
anal fissure