Randomized Clinical Trial Comparing Topical Nitroglycerin And Posterior Perineal Support With Topical Nitroglycerin Only for Chronic Anal Fissure

Background: In recent years medical therapy has largely replaced surgery as first line treatment for chronic anal fissure. Although it is effective, its use has not been widespread because of its side effects. A recent novel innovation using a specially designed toilet seat device has been reported to have encouraging results for the treatment of chronic anal fissure. This device provides posterior perineal support and thus easing defaecation, preventing overstretching and reducing trauma to the anal canal. Methods: We conducted a randomized study involving 42 patients between Dec 2007 to May 2008 to test the hypothesis that combination use topical nitroglycerin 0.2 % and toilet seat device during defaecation is superior to topical nitroglycerin 0.2 % alone in the treatment of chronic anal fissure. Results: In both groups there was a reduction in pain score after 2 weeks of treatment but the difference is not significant. At the end of 6 weeks, 14(63.6%) patients receiving topical nitro-glycerin 0.2 % only had their fissures healed compared to 16(84.2%) patients receiving both topical nitroglycerin 0.2 % and the toilet seat device (p=.138) Conclusion: Combination use of topical nitroglycerin 0.2 % and toilet seat device have a tendency towards a better healing rate for chronic anal fissure than topical nitroglycerin 0.2 % alone but this difference is not significant due to our small sample size.