What is the role of topical nitrates in the treatment of anal fissures?

Updated: Nov 09, 2018
  • Author: Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Topical nitrates have been shown to be effective in the treatment of anal fissures. It is applied directly to the anus and vasodilates blood vessels. In a Cochrane review, topical nitrates were better than placebo in healing anal fissures (48.9% vs 35.5%). However, late recurrence was common (>50%) and headaches occurred frequently, causing cessation of therapy (up to 30%). [25]

In a study of 60 patients with chronic anal fissue, endoanal application of 375 g of 0.2% topical glyceryl trinitrate appeared to be associated with a slight reduction in headache intensity compared to perianal application, with a similar healing rate. [28]


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