From the Guidelines
In Canada, the most effective topical creams for treating anal fissures are calcium channel blockers like diltiazem (2%) and nifedipine (0.2-0.5%), which have been shown to have a healing rate ranging from 65 to 95% with minimal side effects, as reported in a recent systematic review and meta-analysis 1. These medications work by relaxing the internal anal sphincter, improving blood flow to the area, and promoting healing.
- Nitroglycerin ointment (0.2% or 0.4% Rectiv) is also available, but it has been associated with a higher risk of side effects, such as headache, and lower healing rates compared to calcium channel blockers 1.
- Over-the-counter options include zinc oxide creams, petroleum jelly, and lidocaine-based products that can provide temporary relief from pain and discomfort.
- Patients should also implement supportive measures like increasing fiber intake, drinking plenty of water, using sitz baths, and avoiding constipation to enhance healing.
- The topical use of calcium channel blockers is suggested for at least 6 weeks, with pain relief usually occurring after 14 days 1.
- If symptoms don't improve after 6-8 weeks of topical treatment, or if pain is severe, consulting a healthcare provider is recommended as surgical options might be necessary.
From the Research
Topical Creams for Anal Fissures in Canada
- The following topical creams are available for the treatment of anal fissures:
- These creams work by reducing anal tone and sphincter spasm, promoting ulcer healing, and increasing blood flow to the affected area 3, 4
- The efficacy of these creams varies, with GTN ointment showing an efficacy of up to 68% in healing chronic anal fissure, and Diltiazem ointment achieving comparable healing rates with fewer side effects 3
- Botulinum toxin injection is also an effective treatment for chronic anal fissure, with a healing rate of up to 96% 6
- It is essential to consult a healthcare professional to determine the best course of treatment for anal fissures, as the effectiveness of these creams may vary depending on individual circumstances 2, 5