EFFICACY OF TOPICAL NIFEDIPINE IN THE MANAGEMENT OF CHRONIC ANAL FISSURE: A PROSPECTIVE RANDOMISED CONTROLLED STUDY

Background: Chronic anal fissure is the most common cause of anal pain associated with internal anal sphincter hypertonia. Reduction of hypertonocity is a special treatment for fissure healing. For this purpose chronic anal fissures were conventionally treated by anal dilatation or by lateral sphincterotomy. However, both of these methods may cause a degree of incontinence in some patients. The uptake of medical therapies that create a reversible chemical sphincterotomy has recently become widespread. The aim of this prospective clinical trial study was to assess the effectiveness of nifedipine in healing anal fissure, a calcium channel blocker that reduces sphincter pressure. Materials and Methods: 100 patients were included in this randomised open control study in a surgical unit of a medical college hospital, 50 patients in the nifedipine group and 50 patients in the control group and the therapeutic outcome and side effects were recorded. Results: Healing had occurred in 76% of patients in the nifedipine group and in 12% of patients in the control group after 4 weeks of treatment (P < 0.005). Recurrence of symptoms occurred in two patients in the nifedipine group and two patients in the control group after two months. The final result of nifedipine application after 6 months follow up was recurrence in 8 patients (21.05%). Mild headache occurred in four patients (8%) of the nifedipine group. Patients in the nifedipine group showed significant healing and relief from pain compared with patients in the control group Coclusion: Topical nifedipine can be used as an effective conservative therapy for chronic anal fissures, substituting other topical agents.