Evaluation of role of topical 0.2% Glyceryl trinitrate ointment and topical 2% Diltiazem ointment in healing of anal fissure

Backround: The patho-physiology of anal fissure is thought to be related to trauma to the anoderm from any cause. A tear in the anoderm causes acute pain, which results in spasm of the internal anal sphincter and decreased blood supply to the anoderm. Aim: To comparative evaluation of topical 0.2% Glyceryl trinitrate ointment and topical 2% Diltiazem ointment in anal fissure and to evaluate the role of topical 0.2% Glyceryl trinitrate ointment and topical 2% Diltiazem ointment in healing of anal fissure as compared to prevalent conservative treatment i.e. topical anaesthetics. Material and methods: The study was conducted on the patients of anal fissure reported in outpatient department of General Surgery at Guru Gobind Singh Medical College and Hospital, Faridkot including 60 patients which randomized in 3 groups, group A, group B and group C. The data was statistically analyzed using the SPSS version 16. Results: Improvement in constipation after 8 weeks of treatment were 85%, 85% and 80% in Group A, B and C respectively and p value was non-significant (0.887). Improvement in bleeding after 8 weeks of treatment were 90%, 90% and 85% in Group A, B and C respectively and p value was non-significant (0.851). Healing was 78.57%, 92.31% and 46.15% in Group A, B and C respectively. Conclusion: Topical 2% Diltiazem and 0.2% Glyceryl trinitrate ointment are equally effective in healing of chronic anal fissure. However, early pain improvement and fewer side effect profile of Topical 2% Diltiazem ointment; this study suggests it as first line treatment of chronic anal fissure.