Glyceral trinitrate is an effective primary treatment in chronic anal fissure

Background: chronic anal fissure (caf) is a common painful perianal condition and well-known painful entity. non-surgical treatment with 0.2% glyceryl trinitrate (gtn) has shown to be an effective in relieving symptoms and ultimately helpful in healing process. aim: to analyze the effectiveness of 0.2% glyceryl trinitrate paste in the treatment of ch anal fissure. study design: descriptive analytical type of study. place and duration of study: this study was conducted at chaudhary rehmat teaching hospital affiliated with continental medial college lahore from july 2013 to dec 2014. methodology: ninety two patients were included who had agreed for non-surgical treatment with 0.2% glyceryl trinitrate paste. patients were prescribed administration of 0.2% gtn paste with device 1.5 cm to 2 cm inside the anal canal twice daily for 3 months. data was collected on a proforma included detailed history with identifying etiological factors,defecatory pain analysis with vas and serial per-rectal examination finding on f/u visits. all the patients were instructed to keep follow up in opd at 2,4,6,8,10 and 12 weeks and thereafter evaluated for relief of symptoms. result: out of these 92 patients 78(84%) were females with mean age 36.9±7.8 years. more than 50% of patients were pain free at 6 weeks period of continuous use of local application of 0.2% gtn paste and 85% patientshad complete resolution of defecatory pain by 12 weeks and 77% of patients were found to have healed up fissure at 12 weeks. sixteen patients complained of headaches in the initial weeks of local application of gtn paste which caused 5 of them to lost f/u later. conclusion: primary management with 0.2%gtn paste is a cost effective method of treatment with better compliance in our community mostly of low economic levels.