Anal Fissure

Chronic anal fissures can be simply and effectively treated medically without the risk of incontinence associated with sphincterotomy. The American Gastroenterological Association (AGA) has noted: “In most cases, an initial trial of conservative care alone is appropriate, particularly for acute fissures. The timing and choice of additional treatment depend on the chronicity of the fissure, the severity of its symptoms, and the rate and completeness of its response to conservative care. Although lateral internal sphincterotomy (LIS) is the procedure of choice for anal fissures that do not resolve with conservative care or that are simply too painful for conservative care, in a minority of patients, LIS is associated with minor, but sometimes permanent, defects in continence.

Topical therapy is directed at reversibly decreasing resting anal pressure, with a goal of allowing fissure healing without permanent sphincter damage. Several preparations have been used, including compounded nitroglycerin ointment 0.2% (glyceryl trinitrate; GTN). Side effects, particularly headache with higher doses of nitroglycerin ointment such as found in the commercially available 2% product, have been reported, but only infrequently require cessation of therapy with the less concentrated preparations.

Some other commonly prescribed formulations are:

• Diltiazem 2% Rectal Ointment
• Nifedipine 2% Rectal Ointment

Because a long interval of time between first symptoms and treatment negatively affects fissure healing and increases recurrence rate, treatment for anal fissure should be initiated early.

Tech Coloproctol. 2011 Jun;15(2):135-41. Epub 2011 May 3.
The management of patients with primary chronic anal fissure: a position paper.
Altomare DF, Binda GA, Canuti S, Landolfi V, Trompetto M, Villani RD.

Can J Surg. 2006 Feb;49(1):41-5.
Nonsurgical treatment of chronic anal fissure: nitroglycerin and dilatation versus nifedipine and botulinum toxin.

Gastroenterology 2003;124:233–234
American Gastroenterological Association medical position statement: Diagnosis and care of patients with anal fissure, This document presents the official recommendations of the American Gastroenterological Association (AGA) on Anal Fissures. It was approved by the Clinical Practice Committee on May 19, 2002 and by the AGA Governing Board on July 27, 2002.

Low Dose Naltrexone (LDN)

Accumulating evidence suggests that Low Dose Naltrexone can promote health supporting immune-modulation which may reduce various oncogenic and inflammatory autoimmune processes. Since LDN can upregulate endogenous opioid activity, LDN may also play a role in healing and repair of tissues, as well as promoting stress resilience, exercise, social bonding, and emotional well-being, and ameloriating psychiatric problems such as autism and depression. Please contact our pharmacy for more information about LDN compounding.

Med Hypotheses. 2009 Mar;72(3):333-7. Epub 2008 Nov 28.
Low-dose naltrexone for disease prevention and quality of life.
Brown N, Panksepp J.

• Miscellaneous Preparations
• Sodium Butyrate Enema
• Budesonide Enemas
• Diazepam Suppositories
• Thymol in Alcohol
• Glutathione Inhalation Solution
• and many more…