Transdermal nitroglycerine patches show some promise in treating
chronic anal fissures:
"Mean maximum anal resting pressure is directly related to the
activity of the smooth muscles of the internal and external sphincters
and has been found to be increased in the patients of anal fissure. It
has been shown that blood flow at the posterior midline of anoderm is
inversely related to the mean maximum anal resting pressure, and
topical application of glyceryl trinitrate (GTN) ointments is a very
successful treatment. This randomized study was designed to evaluate
the relative value of a nitroglycerin patch applied at a distance from
the fissure site in healing anal fissure compared to GTN ointment and
compared to surgical treatment. Forty-two consecutive patients with
chronic anal fissure of more than 4 months' duration were randomized
into two equally sized groups: those in group A received 0.2% GTN
ointment while those in group B received a 10-mg nitroglycerin patch
for 8 weeks. Patients were also asked to rate their pain intensity on
a scale of 0-10. Five patients were excluded for various reasons;
results were analyzed for the remaining 37 patients (group A, n=18;
group B, n=19). A control group C consisted of 12 patients who
underwent surgical treatment. Fissures healed completely in 12 of 18
(66.7%) patients in group A, 12 of 19 (63.2%) in group B and 11/12
(91.7%) in group C. The healing rates in groups A and B did not differ
significantly (P=0.7), nor was there a difference between these and
surgical group C (P=0.13). The local application of GTN ointment and
the nitroglycerin patch are both effective, economical, and
alternative treatment options for most patients with anal fissures."
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11008725 |
