Topical diltiazem is superior to topical lignocaine in the treatment of chronic anal fissure: Results of a prospective comparative study

Introduction: Fissure in ano is a troubling and painful condition that affects a great majority of the population the world over. Chronic anal fissures are associated with persistent hypertonia and spasm of the internal anal sphincter and they have conventionally been treated surgically. However, concerns have been raised about the risk of faecal incontinence after surgical sphicterotomy. In this study, we have explored topical 2% diltiazem as an effective and a safe alternative method to surgical treatment. Materials and methods: In this prospective comparative study, 200 patients with chronic anal fissure from a single centre were included. They were randomly divided into the test group and the control group, with 100 patients in each group. The test group was instructed to apply 2% topical diltiazem ointment and control group was instructed to apply topical 2% Lignocaine twice daily for 6 consecutive weeks. They were asked to apply the medicine just inside the anal canal and 1cm around the anus circumferentially. The assessment was done at the 2nd, 4th and the 6th weekends for fissure healing, pain relief, bleeding control, control of discharge/perianal itching and for the side effects of the medicines. Results: Complete healing of the fissure was observed in 72% of the patients in the test group against 23% in the control group by the end of 6 weeks (P< 0.0001). The pain relief was also good as the pain score in the test group dropped from 80 (mean) to 5 (mean) over the 6 weeks time. 80% of the test group cases experienced absent bleeding by the end of the 6th week as compared to 42% in the control group (P<0.001). 90% of the subjects in the test group reported a significant reduction in the discharge and the perianal pruritis as compared to 50 % in the control group (P<0.0001). 3 patients had a mild headache, while 10 patients experienced slight perianal pruritis. In the 1 year follow up, 4.28% subjects in the test group reported recurrence of the symptoms against 34.78% in the control group. Conclusion: We conclude that 2% topical diltiazem is quite effective in the treatment of chronic fissure in ano.