A proper application of chemotherapeutic agent at the site of anal fissure: a major concern in healing anal fissure


  • Ambreen Mannan Department of Surgery, Isra University Hospital, Hyderabad, Sindh, Pakistan
  • Muhammad Jarwar Department of Surgery, Isra University Hospital, Hyderabad, Sindh, Pakistan
  • Suhail Ahmed Soomro Department of Surgery, Isra University Hospital, Hyderabad, Sindh, Pakistan




0.2 % GTN, 2% Diltiazem ointment, Anal fissure, Proper peri anal application


Background: To show the efficacy of chemotherapeutic agent by special emphasis on its proper application at the site of anal fissure.

Methods: All patients were seen in outpatient department and were initially started with 0.2% Glyceryl trinitrate ointment along with sitz bath and psyllium fiber as a primary treatment while 2% diltiazem cream reserved for refractory cases. The follow up visits were made weekly for perianal pain relief and ulcer healing rate.

Results: Results in terms of healing of anal fissure and perianal pain relief in 2 or 4 weeks duration were recorded in SPSS version 17. 0.2% GTN ointment showed 75% results in 2 weeks. While complete response was achieved in 95% cases in 4weeks. 2% diltiazem responded in 98% cases in 2 weeks. Non-compliant (2%) abandoned the medical treatment early in the course and proceeded for surgery where 99.99% results were seen in 2weeks only.

Conclusions: Conservative treatment is the gold standard for managing anal fissure. Effective counseling of proper application of ointment at the site of anal fissure is emphasized, which is usually failed by the patient due to intense, excruciating peri anal pain and spasmodic sphincter contraction which led them to proceed to surgery.


Tauro LF, Shindhe VV, Aithala PS, Martis JJ, Shenoy HD. Comparative study of glyceryl trinitrate ointment versus surgical management of chronic anal fissure. Ind J Surg. 2011;73(4):268-77.

Utzig MJ, Kroesen AJ, Buhr HJ. Concepts in pathogenesis and treatment of chronic anal fissure-a review of the literature. Am J Gastroenterol. 2003;98(5):968-74.

Schouten WR, Briel JW, Auwerda JJ, De Graaf EJ. Ischaemic nature of anal fissure. Brit J Surg. 1996;83(1):63-5.

Giridhar CM, Preethitha B, and Rao SK. A comparative study of lateral sphincterotomy and 2% diltiazem gel local application in the treatment of chronic fissure in ano. J Clin Diagn Res. 2014;8:1-2.

Nelson RL, Thomas K, Morgan J, Jones A. Non-surgical therapy for anal fissure. Cochrane Lib; 2012.

Collins EE, Lund JN. A review of chronic anal fissure management. Tech Coloproctol. 2007;11(3):209.

Stewart DB, Gaertner W, Glasgow S, Migaly J, Feingold D, Steele SR. Clinical practice guideline for the management of anal fissures. Dis Colon Rectum. 2017;60(1):7-14.

Gough MJ, Lewis A. The conservative treatment of fissure‐in‐ano. Brit J Surg. 1983;70(3):175-6.

Schlichtemeier S, Engel A. Anal fissure. Aus Prescriber. 2016;39(1):14.

Jiang JK, Chiu JH, Lin JK. Local thermal stimulation relaxes hypertonic anal sphincter. Dis Colon Rectum. 1999;42(9):1152-9.

Shrivastava UK, Jain BK, Kumar P, Saifee Y. A comparison of the effects of diltiazem and glyceryl trinitrate ointment in the treatment of chronic anal fissure: a randomized clinical trial. Surg Today. 2007;37(6):482-5.

Jawaid M, Masood Z, Salim M. Topical diltiazem hydrochloride and glyceryl trinitrate in the treatment of chronic anal fissure. J Coll Physicians Surg Pak. 2009;19(10):614-7.

Griffin N, Acheson AG, Jonas M, Scholefield JH. The role of topical diltiazem in the treatment of chronic anal fissures that have failed glyceryl trinitrate therapy. Colorectal Dis. 2002;4(6):430-5.

Jonas M, Speake W, Scholefield JH. Diltiazem heals glyceryl trinitrate–resistant chronic anal fissures. Dis Colon Rectum. 2002;45(8):1091-5.






Original Research Articles