Background and aim An Anal fissure is a painful tear, often from constipation or childbirth. In chronic cases, healing is delayed due to muscle spasm. Topical glyceryl trinitrate (GTN) and diltiazem (DTZ) help by relaxing the muscle, with DTZ often performing better. This study aimed to compare the effect of topical DTZ 2% and GTN 0.2% in the treatments of chronic anal fissure. Patients and methods This prospective randomized clinical trial included 80 patients (18–60 years) with chronic anal fissure at Al-Azhar Assiut from November 2023. Patients were randomly separated into two groups: one managed with 2% DTZ ointment, the other with 0.2% GTN ointment. Results Before treatment, the main presenting symptoms were constipation, pain, and bleeding. Posterior fissures were found in 90.1% of patients, with skin tags in 75% and sphincter spasm in 62.5%. At 6 weeks, complete healing occurred in 80% of the DTZ group and 75% of the GTN group ( P >0.05). Recurrence rates at 24 weeks were 10% in the DTZ group versus 12.5% in the GTN group. More side effects were reported in the GTN group, notably headache (67.5 vs. 22.5%; P < 0.001). Healing at 8 weeks was comparable (78% DTZ vs. 82.5% GTN; P = 0.775). Pain decreased in both groups with no significant difference throughout follow-up. Conclusion Both DTZ 2% ointment and GTN 0.2% ointment are effective. DTZ showed slightly better healing and fewer headaches, but the difference was not significant.
El-Rahim et al. (2026) studied this question.