Oral nifedipine reduces resting anal pressure and heals chronic anal fissure

Background: Topical preparations have been used in the treatment of anal fi ssure. However, they are not universally successful and there is confusion over the site and dose of application. This study assessed the effectivenes s of oral nifedipine in reducing resting anal pressure and on fissure heali ng. Methods: Anal manometry was performed on eight healthy volunteers and 15 pa tients with chronic anal fissure before and after oral administration of ni fedipine 20 mg. Nifedipine was taken twice daily. Fissure healing was asses sed over an 8-week period and pain scores were monitored. Results: Oral nifedipine produced an initial reduction in maximum resting a nal pressure (MRP) of 35 per cent (P < 0.001) and of 28 per cent after 5 da ys (P < 0.001) in healthy volunteers. A reduction in IMRP of 36 per cent (P < 0.001) was observed in patients with fissure. Pain scores were significa ntly reduced during the treatment period. Healing was complete in nine pati ents after 8 weeks and a further three were asymptomatic. Ten patients expe rience flushing and four had mild headaches. There were no episodes of post ural hypotension or incontinence. Conclusion: Oral nifedipine reduces resting anal pressure. It is well toler ated and offers an alternative treatment for chronic anal fissure.