Background: Chronic anal fissure has traditionally been treated surgically.
Initial enthusiasm for chemical sphincterotomy has waned because of poor o
utcomes with glyceryl trinitrate ointment. In this study the use of topical
2 per cent diltiazem ointment has been investigated as an alternative meth
od of chemical sphincterotomy.
Methods: A prospective assessment of 71 consecutive patients with a chronic
anal fissure treated with 2 per cent topical diltiazem ointment for a medi
an duration of 9 (range 2-16) weeks was performed.
Results: Fifty-one patients (75 per cent) experienced healing of the fissur
e after 2-3 months of treatment with topical diltiazem. Seventeen patients
who did not heal were treated for a further 8 weeks with topical diltiazem.
Eight of these patients subsequently healed with diltiazem. Fifty-nine of
67 patients who completed follow-up therefore healed on diltiazem ointment.
Four patients experienced perianal dermatitis and one patient experienced
headaches. No other side-effects were recorded. After a median of 32 (range
14-67) weeks' follow-up following completion of treatment, 27 of 41 patien
ts available remain symptom free. Six of seven patients with recurrent fiss
ure were treated successfully by repeat chemical sphincterotomy.
Conclusion: Topical 2 per cent diltiazem ointment used as an agent for chem
ical sphincterotomy for chronic anal fissure offers significant healing rat
es but does not have a significant side-effect profile, which may aid compl
iance to treatment. Early recurrences are common but usually amenable to fu
rther chemical sphincterotomy.