Benefits of topical nifedipine in healing anal fissure
What is constipation?
An anal fissure is a tear in the skin of the anus near the anal sphincter that causes spasm of the anal sphincter with consequent gaping of the tear and pain for the patient.
Nifedipine is available as a pill and is also used in the treatment of hypertension, premature labour (as a tocolytic). It is also available as an ointment and used for the treatment of thrombosed external hemorrhoids.
Oral nifedipine is also used to treat anal fissures but it is associated with high occurrence of side effects. However, nifedipine is best used for anal fissure treatment when made into gel form and applied directly to the fissure. Topical treatment with 0.2% nifedipine four times a day has few side effects.
Topical nifedipine has a higher success rate than other treatments.
How it works
Nifedipine is a calcium channel blocker (CCB).
Calcium channel blockers cause relaxation of the internal anal sphincter by blocking calcium influx into smooth muscle cells, causing muscle relaxation and vascular dilatation.
This causes a decrease in the mean anal sphincter resting tone and improves fissure healing by bringing the tissues together.
Benefits of topical nifedipine
ОIt has higher healing rates than other topical medications: diltiazem, nitroglycerin and botulinum toxin are less effective compared to nifedipine
It has a better side effect-profile, since patients have fewer side effects than with nitrates: nitroglycerin causes headaches
It can be used as first-line treatment for anal fissures due to its high efficacy
Apart from promoting healing, it also reduces pain and may be used for analgesia: as it reduces the tension in the anal sphincter, it also reduces the stretching of the inflamed tissue and pain is therefore reduced
Topical nifedipine offers a better-tolerated alternative to treatment than surgery which is associated with considerable pain and some disruption of physical activities
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