Aims-To determine the effectiveness and safety of topical glyceryl trinitra
te (GTN) in the management of acute anal fissure in children.
Methods-Individual children were randomised to receive GTN paste or placebo
for six weeks in addition to oral senna and lactulose. Patients took laxat
ives alone for a further 10 weeks. Each week a research nurse telephoned fa
milies to assess pain scores and give advice. Main outcome measures were va
lidated standardised pain scores and time to painless defaecation.
Results-Forty subjects were recruited from 46 eligible children; 31 childre
n completed the trial (13 in the GTN group and 18 in the placebo group). No
differences in the proportion of those achieving pain free defaecation wit
h relation to time were seen between the two groups. Similarly, there were
no significant differences in pain scores between the two groups over the 1
6 week study period. However, in both groups pain scores had decreased sign
ificantly. There were no differences in the incidence of rectal bleeding, f
aecal soiling, presence of visible fissure, skin tag, or faecal loading at
outpatient review at the time of recruitment, or at 6 weeks and 16 weeks. N
o serious adverse effects were observed.
Conclusions-This study suggests that 0.2% GTN paste is ineffective in the t
reatment of acute anal fissures in childhood. However the overall fissure h
ealing rate is high (84%) with associated reduction in pain scores, suggest
ing that a nurse based treatment programme can achieve a high rate of fissu
re healing.