Nitroglycerine compound ointment versus antihaemorrhoid alone in

treatment of fissure in ano

Hiwa Omer Ahmed

Medical 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

50%
35y-40y, 3% 0y-5y, 0% 5y-10y, 0%
30y-35y,
40%4% 0y-5y

10y-15y, 5% 5y-10y
30%
25y-30y, 5%
10y-15y
male 15y-20y
20%
15y-20y, 41% 20y-25y
10% female
25y-30y
0% 30y-35y
20y-25y, 42%
0y-5y 5y-10y 10y-15y 15y-20y 20y-25y 25y-30y 30y-35y 35y-40y
35y-40y