USE OF GLYCERYL TRINITRATE OINTMENT IN THE TREATMENT OF ANAL-FISSURE

Anal fissure is often treated surgically by sphincterotomy. There is g rowing concern over the effects of this procedure on continence, Nitri c oxide donors such as glyceryl trinitrate are thought to cause a reve rsible 'chemical sphincterotomy', capable of healing the fissure. Twen ty-one consecutive patients with chronic anal fissure (13 women,mean a ge 36 years) were treated for 4-6 weeks with 0.2 per cent glyceryl tri nitrate ointment applied to the fissure twice daily. Maximum anal rest ing pressure (MARP) was measured before and after application of the o intment at the first visit, There were 16 posterior and five anterior fissures. Mean(s.d.) MARP felt from 118.7(45.0) to 70.3(34.1)cmH(2)O o ver 20 min after application of the ointment (P < 0.001). Healing was complete in 11 patients at 4 weeks and in 18 at 6 weeks. The fissure r ecurred in four patients after cessation of treatment; three were succ essfully treated by further glyceryl trinitrate. Mild headache occurre d in four patients. Anal fissure can be successfully treated with 0.2 per cent glyceryl trinitrate ointment applied topically.