Nitroglycerine compound ointment versus antihaemorrhoid alone intreatment 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.comdrhiwaomerahmed@gmail.com

ABSTRACT

;

In this study the effect of a combination of Nitro-Glycerinwas 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 werereceived 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 werereceived Anti-hemorrhoid ointment . The aim of this work is to evaluate effect of Nitroglycerincompound in comparison to usual treatment: Anti-hemorrhoid ointment. We can conclude thatthe 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 canalusually located in the posterior commissar in the midline. Location may vary,and an anterior midline fissure is seen more often in women, although mostfissures in women occur in the posterior midline. Because it involves the highlysensitive 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 proceduresin the form of lateral internal sphincterotomy and because of well known injuries& complications of the surgical options from Lord’s dilatation to lateralsphincterotomy 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 andsufficient 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 inano, recent studies have demonstrated efficiency of tropical Nitroglycerin inhealing 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 criticalwhen associated with internal anal sphincter spasm [4] Conventional treatmentshave 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 sufferingfrom chronic anal fissures, seeking advices in Slemani Teaching Hospital,Surgical Consulting Room & Private Clinic. Over a period of six years; from 1

Feb. 1999 to 31

Jan. 2005.The fissures were diagnosed on clinical history and inspection of the perineumas in figure 1,

malefemale