Comparison of topical agents minoxidil and diltiazem in medical management of anal fissures: a hospital based study

Authors

  • Naseer Ahmad Awan Department of Surgery, Government Medical College, Srinagar, Jammu and Kashmir, India
  • Irfan Nazir Mir Department of Surgery, Government Medical College, Srinagar, Jammu and Kashmir, India
  • Hila Ahmad Wani Department of Surgery, Government Medical College, Srinagar, Jammu and Kashmir, India
  • Mir Mujtaba Ahmad Department of Surgery, HIMSR, New Delhi, India

DOI:

https://doi.org/10.18203/2349-2902.isj20175141

Keywords:

Diltiazem, Internal anal sphincter (IAS), Minoxidil

Abstract

Background: Anal fissures are associated with spasm of the internal anal sphincter and pain. In present study we compared the efficacy of local application of 0.5% minoxidil and 2% diltiazem in symptomatic relief and healing of anal fissures.

Methods: In this prospective, randomized, double blind study, a total of 100 patients with anal fissure were recruited, (50 patients in each group). Patients in group A received local applications of ointments containing 0.5% minoxidil, while patients in group B received topical 2% Diltiazem. Healing of anal fissure and symptomatic relief were observed and analyzed.

Results: Rates of complete healing of fissure were similar in the two groups (minoxidil 27/50, diltiazem 29/50). Mean (SD) time taken for complete healing was significantly shorter with minoxidil (3.1 weeks as compared to diltiazem (4 weeks). Rates of pain relief were similar in the two groups. Stoppage of bleeding occurred more often with use of minoxidil than with diltiazem. No patient had systemic or local side effects.

Conclusions: Treatment with minoxidil helps in faster healing of anal fissures and provides similar symptomatic relief as that of diltiazem.

Metrics

Metrics Loading ...

References

Kodner IJ, Fry RD, Fleshman JW. Colon rectum and anus. In: Schwartz’s Principles of Surgery. 7th edition. USA: McGraw Hill; 1999:1265.

Gibbons CP, Read NW. Anal hypertonia in fissures: cause or effect? Br J Surg. 1986;73:443-5.

Klosterhalfen B, Vogel P, Rixen H, Mittermayer C. Topography of the inferior rectal artery: a possible cause of chronic, primary anal fissure. Dis Colon Rectum. 1989;32:43-52.

Lewis TH, Corman ML, Prager ED, Robertson WG. Long term results of open and closed sphincterotomy for anal fissure. Dis Colon Rectum. 1988;31:368-71.

Lund JN, Armitage NC, Scholefield JH. Use of glyceryl trinitrate ointment in the treatment of anal fissure. Br J Surg. 1996;83:776-7.

Schouten WR, Briel JW, Boerma MO, Auwerda JJ, Wilms EB, Graatsma BH. Pathophysiological aspects and clinical outcome of intra-anal application of isosorbide-dinitrate in patients with chronic anal fissure. Gut. 1996;39:465-9.

Jost WH, Schimrigk K. Therapy of anal fissure using botulin toxin. Dis Colon Rectum 1994;37:1321-4.

Antropoli C, Perrotti P, Rubino M, Martino A, De Stefano G, Migliore G, et al. Nifedipine for local use in conservative treatment of anal fissures: preliminary results of the multicentre study. Dis Colon Rectum. 1999;42:1011-5.

Jonas M, Neal KR, Abercrombie JF, Scholefield JH. A randomized trial of oral vs. topical diltiazem for chronic anal fissure. Dis Colon Rectum. 2001;44:1074-8.

Maan MS, Mishra R, Thomas S, Hadke NS. Randomized, double-blind trial comparing topical nitro-glycerine with xylocaine and Proctosedyl in idiopathic chronic anal fissure. Indian J Gastroenterol. 2004;23:91-3.

Meisheri KD, Cipkus LA, Taylor CJ. Mechanism of action of minoxidil sulfate-induced vasodilatation: a role for increased K+ permeability. J Pharmacol Exp Ther. 1988;245:751-60.

Wester RC, Maibach HI, Guy RH, Novak F. Minoxidil stimulates cutaneous blood flow in human balding scalps: pharmacodynamics measured by laser Doppler velocimetry and photo pulse plethysmography. J Invest Dermatol. 1984;82:515-7.

Eller MG, Szpunar GJ, Della-Coletta AA. Absorption of minoxidil after topical application. Clin Pharmacol Therap. 1989;45:396-402.

Notaras MJ. The treatment of anal fissure by lateral subcutaneous internal sphincterotomy for anal fissure. Br J Surg. 1971;58:96-100.

Kennedy ML, Sowter S, Nguyen H, Lubowski DZ. Glyceryl trinitrate ointment for the treatment of chronic anal fissure. Dis Colon Rectum. 1999;42:1000-6.

Rajakannu M, Robinson Smile S, Sistla SC, Raveendran R. Treatment of anal fissures using a combination of minoxidil and Lignocaine. Indian J Gastroenterol. 2005;24:158-60.

Knight JS, Birks M, Farouk R. Topical diltiazem ointment in the treatment of chronic anal fissure. Br J Surg. 2001;88:553-6.

Downloads

Published

2017-11-25

How to Cite

Awan, N. A., Mir, I. N., Wani, H. A., & Ahmad, M. M. (2017). Comparison of topical agents minoxidil and diltiazem in medical management of anal fissures: a hospital based study. International Surgery Journal, 4(12), 3939–3942. https://doi.org/10.18203/2349-2902.isj20175141

Issue

Section

Original Research Articles