Nitroglycerin ointment for anal fissures - Effective treatment or just a headache?

PURPOSE: Topical nitrates have been shown to cause nitric oxide-mediated re laxation of the internal anal sphincter. Previous reports have suggested in itial efficacy in the treatment of anal fissures. The aim of this study was to assess the longer-term usefulness of this treatment. METHODS: Thirty-th ree patients with an anal fissure were treated with topical 0.3% nitroglyce rin ointment, applied to the anoderm three times per day and after bowel mo vements. Patients were followed up by office visits and telephone calls unt il symptoms were completely resolved or treatment was noted to be ineffecti ve or intolerable. RESULTS: Thirty-three patients were treated, IG with acu te fissures, and 17 with chronic fissures. Nitroglycerin was effective in 9 of 16 acute fissures (56%), and 7 of 17 chronic fissures (41%). Even when effective, 75% of patients reported an adverse reaction. CONCLUSIONS: Topic al nitroglycerin was only effective in approximately one-half of patients w ith an anal fissure. There was a very high incidence of adverse reactions. In our experience nitroglycerin more often causes a headache than treats th e symptoms of anal fissure.