Treatment of Acute Fissure in Ano using Topical Glycerine Trinitrate and Manual Anal Dilatation at the University Teaching Hospital, Lusaka

Abstract

Objective: To compare the effectiveness of topical glycerine trinitratrate (GTN) cream to manual dilatation of the anus (MDA) method in the treatment of acute fissure in ano.
Method: Two cohorts each consisting of 34 participants with acute fissure in ano were selected. One cohort was treated with the manual dilatation of anus (MDA) while the other with 0.25% topical glycerine trinitrate (GTN) cream. Participants were followed for a period of 6 (six) weeks during which they were assessed for fissure healing at two weekly intervals. Fissure healing was defined as absence of fissure pain. Pain was quantified using numerical rating scale.
Results: Cure rate for the MDA group was 28 (82.4%) while that for GTN group was 31 (91.2%) giving a RR of 1.11 at the end of six (6) weeks follow up. Seven Participants (10.3%) all from the GTN cohort developed headache during the course of treatment. The observed side effect was effectively treated using paracetamol. There were however no other adverse events that were observed.
Conclusion: Both treatment methods showed effectiveness in the treatment of acute fissure in ano. However response to treatment was noted to be better with the MDA cohort compared to the GTN one as fissure healing was faster. Therefore MDA should be maintained as the first line treatment method for acute fissure in ano treatment at UTH and other hospitals in Zambia. Treatment with 0.25% GTN cream should be reserved for participants who decline MDA, health institutions where theatre facilities are not available or conditions where there are contraindications to surgery.