ArticleCureus2025
Short-Term Efficacy of 2% Topical Diltiazem in Fissure in Ano: A Prospective Observational Study From a Tertiary Care Centre in a Sub-Himalayan Region in India.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionAn anal fissure is a common anorectal condition characterised by a linear tear in the lower anal canal, causing severe pain and rectal bleeding. Topical chemical sphincterotomy using agents such as diltiazem has become a popular non-surgical treatment option.
methodsThis prospective observational study was carried out over 12 months at the Department of Surgery, Himalayan Institute of Medical Sciences, Dehradun, India. Six hundred patients aged 18-60 years with acute, acute-on-chronic, or chronic anal fissure and no previous treatment history were enrolled. Patients received 2% topical diltiazem applied locally twice daily for eight weeks. The amount of ointment applied was equivalent to the size of a pea; the patients were compliant throughout the study. Pain was evaluated using the visual analogue scale (VAS) at baseline, and after the first, second, and third weeks, as well as at three months. Data on side effects, the need for surgery, and fissure recurrence were also documented.
resultsThe mean age was 34.17 ± 8.90 years, with a slight female predominance (53.3%). Pain scores decreased significantly over three months (p<0.001), with 75% of patients pain-free at three months. Mild perianal redness and itching were reported in 4.1% during the first week, with no adverse effects thereafter. Surgical intervention was required in 4% of cases by three months, and fissure recurrence occurred in 5%.
conclusionTopical 2% diltiazem is an effective, well-tolerated, and safe treatment for anal fissures, providing significant symptomatic relief and good healing potential with minimal side effects.
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