Nitroglycerine compound ointment versus antihaemorrhoid alone in treatment of fissure in ano

Hiwa Omer AhmedMedical College, University of Sulaimani. Kurdistan

Region, Iraq

 

Azad Noori Abdulla   M.Sc. Clinical Pharmacy*

*Technical Institute of Sulaimani

                                          drhiwaomer@hatwan.com     drhiwaomerahmed@gmail.com

        

   ABSTRACT ;  

                                        In this study the effect of a

combination of Nitro-Glycerin was studied & compared to the effect of

usual treatment which is anti-hemorrhoid ointment. Hence  976 patient

were included and evaluated. The first group [567 Patients] who were

received Nitroglycerin compound ointment, , were divided to three

subgroups A,B and C  & compared  to the second group of the same age

& sex with chronic anal fissures who were received Anti-hemorrhoid

ointment . The aim of this work is to evaluate effect of Nitroglycerin

compound in comparison to usual treatment: Anti-hemorrhoid ointment.

We can conclude that the combination was more effective than anti-

hemorrhoid ointment alone.  

 

Key word; Nitroglycerin, anti-hemorrhoid, Ointment Fissure

in ano

 

INTRODUCTION;

                 Fissure in Ano is a linear ulcer of the

lower half of the anal canal usually located in the posterior

commissar in the midline. Location may vary, and an

anterior midline fissure is seen more often in women,

although most fissures in women occur in the posterior

midline. Because it involves the highly sensitive squamous

epithelium, it is often a very painful condition. . In some

patients, the fissure heals with the use of conservative

measures to avoid constipation and decrease pain. The

remainder require minor surgical procedures in the form of

lateral internal sphincterotomy and because of well known

injuries & complications of the surgical options from Lord’s

dilatation to lateral sphincterotomy must be compared with

appropriate medical regimens. [1].

 

Conservative measures include emollient suppositories,

psyllium seeds, and Sitz baths .In the only reported

prospective trial, a combination of Sitz baths and sufficient

amounts of bran (5 gm. per day) appeared to be effective.

Anti-hemorrhoid ointment has been used for long period in

the treatment of fissure in ano, recent studies have

demonstrated efficiency of tropical Nitroglycerin in healing

of anal fissures [2].

Nitroglycerin is one of the organic Nitrate compounds,

which donates NO (Nitrous Oxide) [3].

There are anatomical & physiological evidences that the anal

canal is relatively poorly perfused, especially in the posterior

midline and this ischemia is critical when associated with

internal anal sphincter spasm  [4] Conventional treatments

have included a combination of an increase in dietary

fiber ,the application of topical local anesthetics preparations

& laxatives.

 

PATIENTS & METHODES ;

                     This is a prospective work including 976

patients, were suffering from chronic anal fissures, seeking

advices in Slemani Teaching Hospital, Surgical Consulting

Room & Private Clinic. Over a period of six years; from 1st

Feb. 1999 to 31st Jan. 2005.                   

    The fissures were diagnosed on clinical history and

inspection of the perineum as in figure 1 ,

 

 

 

 

 

 

 

 

 

 

 

                          Figure 1; Bleeding Fissure in Ano

Patients were collected in to two groups with further

subdivision as shown in figure 2.   First group were 576

patients with chronic anal fissure, 329 female & 247 male as

shown in figure 3.

 

 

 

 

 

0y-5y, 0%

10y-15y, 5%

20y-25y, 42%

25y-30y, 5%

30y-35y, 4%35y-40y, 3% 5y-10y, 0%

15y-20y, 41%

0y-5y

5y-10y

10y-15y

15y-20y

20y-25y

25y-30y

30y-35y

35y-40y

 

 

 

 

                                       Figure 2; the age groups of the

patients

 

 

 

 

 

 

 

 

 

                                     Figure 3; the ratio of male to female

 

            Majority (83 %) were in (15 – 25) years of age as

shown in figure 4 . Thirty five percent of the females had

developed the fissures at Labor. Fissures were in posterior

midline in 95% and anterior midline in 5% .all the patients

with posterior fissure were male.

 

 

 

 

 

 

 

 

 

                          Figure 4; the peak age period for anal fissure

 

 

                                          All of them were put on 0.2%

Nitroglycerin (as shown in figure 5) in anti-hemorrhoid

male

female

0%

10%

20%

30%

40%

50%

0y-5y 5y-10y 10y-15y 15y-20y 20y-25y 25y-30y 30y-35y 35y-40y