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Breakthrough treatment proves 90 success rate on painful anal fissures. Topical diltiazem and bethanechol decrease anal sphincter pressure and heal anal fissures without side effects. Author information (1)st marks hospital, london, united kingdom. Purpose topical glyceryl trinitrate heals anal fissures, but a majority of patients experience headache. In all, 9 studies have looked at how well diltiazem cream or ointment works for treating anal fissures. Only 1 of these studies looked at how well it worked compared with using no treatment. The anal fissure healed completely in 24 out of 30 adults who were using the diltiazem ointment compared with 10 out of 30 adults who were not using anything. Topical 2 per cent diltiazem ointment used as an agent for chemical sphincterotomy for chronic anal fissure offers significant healing rates but does not have a significant side-effect profile, which may aid compliance to treatment. diltiazem and lidocaine are important medications in the treatment of anal fissures. Diltiazem relaxes the anal sphincter to aid in the healing process. Doctors avoid prescribing narcotic pain medications for anal fissures because narcotics can cause constipation, which could worsen anal fissures. Topical diltiazem is more effective, achieving healing rates comparable to those reported with topical nitrates, with significantly fewer side effects. trials have shown that the topical treatment with 2 diltiazem cream is effective and it will promote healing most chronic anal fissures. T he effectiveness of topical treatment of anal fissure with diltiazem has been compared to other pharmacotherapies or surgical procedures. Topical diltiazem and bta are promising agents in the treatment of anal fissure. As to date diltiazem and bta were never compared in a solid randomized trial, which is the purpose of this study. Methods one hundred thirty-four patients were randomized to receive either diltiazem cream and placebo injection or bta injection and placebo cream. Methods fifty consecutive patients with chronic anal fissures were randomly assigned to receive oral (60 mg) or topical (2 percent gel) diltiazem twice daily for up to eight weeks. Anal manometry was performed before and after the first dose, and blood pressure was recorded at 15-minute intervals. An anal fissure is a tear in the skin of the lower half of the anal canal (back passage). Symptoms can include severe and sharp pain, irritation and tenderness. Certain fissures may heal quite quickly, whereas others can take several months to heal. Diltiazem hydrochloride works by relaxing the muscle around the anus (the anal sphincter). Primary fissures are usually benign and located in the posterior or anterior position. Secondary fissures are lateral or multiple and often indicate a more serious underlying pathology. The management of primary anal fissures is generally non-operative and includes increased dietary fibre, sitz baths, topical ointments and botulinum toxin. Breakthrough treatment proves 90 success rate on painful anal fissures.