What is the best therapy for anal fissures?

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Abstract

EVIDENCE-BASED ANSWER

Surgical management is consistently superior to topical diltiazem or glyceryl trinitrate for chronic anal fissure (SOR: A, systematic review and meta-analysis) and perhaps also for acute anal fissure (SOR: C, small cohort study). Among medical therapies, diltiazem 2% ointment and glyceryl trinitrate 0.2% ointment are equally effective, but diltiazem has a 30% lower recurrence rate and a 60% lower incidence of headache (SOR: A, systematic review of RCTs).

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