Topical Combination of Nifedipine with Lidocaine is a Promising Medical Treatment for Anal Fissure

Abstract

Background: A fissure consist of crack or tear in the vertical axis of the anal canal between the anal verge and the dentate line. Anal fissure is the most common cause of sever anal pain and bleeding. Anal fissure is an elongated ulcer in the anoderm below the dentate line, and is commonly located posteriorly due to more adherence of the anoderm to the underlying tissue in the posterior midline, so the blood supply is significantly low as shown by the Doppler flowmetry study. Anal fissure is treated by two ways either medical or surgical treatment or both. Objective:To evaluate the healing response of the anal fissure to topical application of nifedipine with lidocaine. Patients and Methods: A randomized prospective study of one hundred patients who presented with anal fissure to outpatient surgical clinic in Al-Diwaniyah teaching hospital. The patients were divided into two groups. The first group involve 40 patients (15 males and 25 females) with acute anal fissure; the second group 60 patients (25 males and 35 females) with chronic anal fissure. Both groups were treated with the topical application of nifedipine and lidocaine 3 times daily for 6 weeks, and more prolonged therapy (up to 8 weeks) was applied for resistant cases. Results: Both groups registered good response to topical therapy; the healing response was 85%. The healing response of those with acute anal fissure was better and faster than patients with chronic anal fissure. Conclusion: Anal fissure can be simply and effectively treated medically without the risk of incontinence associated with lateral internal sphincterotomy.