Non surgical therapy for chronic anal fissure

Abstract

Introduction. Sphincterotomy is a pathogenetically justified method of surgical treatment of chronic anal fissures with spasm of the sphincter, but the risk of anal incontinence can reach 44%. Therefore, other methods are being sought to eliminate spasm of the sphincter, and the greatest interest is the medical relaxation of the internal sphincter. Aim. Тo determine the efficacy and limitations of the use combined preparation in the form of a gel of 0.3% nifedipine and 2.0% lidocaine for the treatment of chronic anal fissure. Materials and methods. All patients included in the study were recommended to apply gel 2 times a day with an interval of 12 hours on the skin of the anus and inside the anal canal. In total, the results of treatment of 40 patients were analyzed. Results. Before the start of treatment, the average pain during defecation was 5 (4.5; 7), on the third day of treatment – 4 (4; 5), and on the 10th day – 2 (2; 3). By day 10, 80% (32) of patients refused to take painkillers. On day 21, complete epithelialization was observed in 31 (77.5%) patients. The average healing time of anal fissures was 17 ± 3 days. In patients with complete epithelization of anal fissures, according to the results of EMG on the 21st day of therapy, spontaneous wave activity was absent. In 9 patients, despite the reduction of pain, sphincter spasm persisted after therapy and cracks in the anal canal did not heal. Discussion. When analyzing the reasons that led to the ineffectiveness of the use of gel, it was revealed that in all cases, according to ultrasound studies, there were fibrous changes in the internal anal sphincter. Conclusion. Summarizing the above-mentioned, we can state that the use of a fixed-dose combination of 0.3% nifedipine and 2.0% lidocaine is effective for the treatment of chronic anal fissure with sphincter spasm.