An anal fissure is a linear wound or a tear in the anoderm, or skin around the anal canal. It is accompanied by excruciating pain during bowel movements, constipation, involuntary anal muscle contractions, bleeding and other symptoms. Although somewhat bearable, these symptoms may get in the way of work and normal daily routine.
In order to address these symptoms and heal the wound, there are a variety of treatments available. Among these methods is the application of topical ointments or gels that may be prescribed by the physician. The most common of which are glyceryl trinitrate and diltiazem. To know which between the two is better, it is essential to differentiate between them and look into their pros and cons.
Glyceryl trinitrate or nitroglycerin
Glyceryl trinitrate or nitroglycerin in the form of an ointment used for anal fissures is at 0.2% concentration. This is used by applying the cream on the affected area. The recommended time would be at night right after a warm bath for faster absorption. The role of glyceryl trinitrate in fissure relief is as a muscle relaxant. This helps with treatment because the spasms (involuntary contraction) of the muscles surrounding the canal, called anal sphincter, is associated with the impediment of blood flow to the affected area. Blood flow is necessary for treatment because oxygenated blood carries antibodies that help with healing of wounds.
Studies prove that nitroglycerin is effective at healing anal fissures. One study showed that out of 51 patients made up of men and women having chronic anal fissures, 70.6% had less symptoms after using this ointment. Furthermore, a total of 54.9% were completely healed. The only setback for this medication is that it has a high chance of causing headaches, its main side effect.
Diltiazem
Diltiazem ointment with a 2% concentration of diltiazem hydrochloride is a CCB (calcium channel blocker) drug that also helps relax the muscles of the anal sphincter. It also opens up blood vessels in order to facilitate more blood flow to the area. Like glyceryl trinitrate, it is also applied on the skin surface affected. But unlike it, diltiazem ointment has less occurrence of side effects and it causes lower chances of patients to acquire fissures again after healing.
In the same study conducted with nitroglycerin ointment, 88.2% out of 51 patients who used diltiazem showed less symptoms of anal fissures and 72.5% had symptoms eliminated. Although this is a higher rate than glyceryl trinitrate use, it is considered an insignificant difference.
Other studies have been conducted to test and compare glyceryl trinitrate and diltiazem on the treatment of anal fissure. These ended with the same conclusion that both of these medications are effective in healing fissures by reducing the symptoms and preventing the condition from recurring with a little difference leaning in favor of diltiazem. The high chances of side effects in nitroglycerin, however, is reason enough to choose diltiazem.
Although there is availability of medication that helps treat anal fissures, and they may help in preventing recurrence, the possibility of developing them again still exists. One time is all it takes. It is therefore vital to follow proper diet, with fiber rich foods and lots of water, and exercise to avoid this.
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