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Official websites use. Share sensitive information only on official, secure websites. Because of the disability associated with surgery for anal fissure and the risk of incontinence, medical alternatives for surgery have been sought. Most recently, pharmacologic methods that relax the anal smooth muscle, to accomplish reversibly what occurs in surgery, have been used to obtain fissure healing. Search terms include "anal fissure randomized". Timing from to August Further details of the search below.

Comparison groups may include an operative procedure, an alternate medical therapy or placebo. Chronic fissure, acute fissure and fissure in children are included in the review. Atypical fissures associated with inflammatory bowel disease or cancer or anal infection are excluded. Continuous outcome measures included measures of pain relief and anorectal manometry.

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In this update 23 studies including participants is added to the 54 studies and participants in the publication, however 2 studies were from the last version reclassified as un included, so the final number of participants is GTN was found to be marginally but significantly better than placebo in healing anal fissure No medical therapy came close to the efficacy of surgical sphincterotomy, though none of the medical therapies in these RCTs were associated with the risk of incontinence.

Medical therapy for chronic anal fissure, currently consisting of topical glyceryl trinitrate, botulinum toxin injection or the topical calcium channel blockers nifedipine or diltiazem in acute and chronic fissure and fissure in children may be applied with a chance of cure that is marginally better than placebo.

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For chronic fissure in adults all medical therapies are far less effective than surgery. A few of the newer agents investigated show promise based only upon single studies clove oil, sildenifil and a "healer cream" but lack comparison to more established medications. Anal fissure is a painful ulcer usually occurring in the posterior midline of the skin just outside the entry to the rectum.

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