A Comparative Study of Topical 2% Diltiazem Versus Lateral Internal Sphincterotomy in the Treatment of Fissure-in-Ano

Sep 29, 2026

Chronic anal fissure is a common surgical condition, and lateral internal sphincterotomy is widely treated as the gold standard; however, improved understanding of pathophysiology supports better conservative options. This prospective, randomized comparative study evaluates topical 2% diltiazem gel versus lateral internal sphincterotomy for healing, symptomatic relief, and side effects. One hundred patients were randomized and followed over weeks and months with outcomes including pain, healing, incontinence, and recurrence.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Introduction

Material and methods

Results

Conclusion

Introduction

Definition and clinical features

Treatment rationale

Topical 2% Diltiazem background

Study aim and context

Review began 11/05/2025 Review ended 11/29/2025 Published 12/07/2025 © Copyright 2025 Siripurapu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98615 Open Access Original Article A Comparative Study of Topical 2% Diltiazem Versus Lateral Internal Sphincterotomy in the Treatment of Fissure-in-Ano Simhadri Siripurapu 1, Rajani Devi Gosala 1, Sri Satya Sudha Tula 2 , Vijaya Petta 1, Kusa R. Pyla 3 1. General Surgery, Rangaraya Medical College, Kakinada, IND 2. Plastic Surgery, Rangaraya Medical College, Kakinada, IND 3. Pathology, Rangaraya Medical College, Kakinada, IND Corresponding author: Simhadri Siripurapu, [drsimhadri109@gmail.com](drsimhadri109@gmail.com) Abstract Introduction: Chronic anal fissure is a common clinical entity seen in surgical practice. Lateral internal sphincterotomy is considered the gold standard for treating chronic fissures. But recent developments in understanding the pathophysiology of anal fissures have helped to develop better conservative treatment options. In this study, we compare the healing, symptomatic relief, and side effects of topical 2% Diltiazem gel versus lateral internal sphincterotomy in the treatment of chronic anal fissures. Material and methods: In this prospective, randomised comparative study, 100 patients with chronic anal fissure were randomly divided into group A (Diltiazem gel) and group B (lateral internal sphincterotomy) . Each group has 50 patients. Patients were followed up at the first, second, and third weeks and first, second, and third months, and symptomatic relief, healing, and side effects were noted for each group. Results: More than 90% of the subjects in group A had a pain scale ≤ 3 . Among group B, two subjects (4%) had pain rated as 4 after two weeks of treatment. The rate of healing in patients belonging to groups A and Bis 82% and 68%, respectively, at the end of three months. In group A, one patient and, in group B, 15 patients showed flatus incontinence at six months. In group A, six (12%) patients and, in group B, one (2%) patient had recurrence. Conclusion: Study concludes that lateral internal sphincterotomy remains the gold standard treatment for chronic anal fissure. Diltiazem therapy is a good alternative for patients who refused surgery or prefer medical line of treatment and can be used as a first choice in management of chronic fissures. Categories: General Surgery Keywords: 2% diltiazem cream, chronic anal fissure, effectiveness of healing, lateral anal sphincterotomy, recurrence Introduction An anal fissure is a common and painful condition that affects the anal canal. It is characterized by a tear or crack in the mucosa that exposes the underlying muscle. The main symptom is severe pain during and after defecation, often accompanied by bleeding. An anal fissure can be acute or chronic, depending on the duration and healing of the lesion. A chronic anal fissure is defined as a fissure that persists for more than six weeks and is associated with hypertonia and spasm of the internal anal sphincter [1] . The treatment of chronic anal fissures aims to relieve pain, promote healing, and prevent recurrence. The standard surgical treatment is lateral internal sphincterotomy, which involves cutting a part of the internal anal sphincter to reduce the resting pressure and improve blood flow to the fissure. However, this procedure has some drawbacks, such as the risk of incontinence, infection, and recurrence. Therefore, alternative treatments have been sought to avoid surgery and its complications. One of the most promising alternatives is the use of topical 2% Diltiazem, ability to decrease calcium influx into the smooth muscle cells of internal anal sphincter that causes relaxation o

FAQs

What treatments were compared for chronic anal fissure?

Topical 2% diltiazem gel was compared with lateral internal sphincterotomy for healing, symptom relief, and side effects.

How was the study designed and how many patients were included?

This prospective, randomized comparative study enrolled 100 patients with chronic anal fissure, dividing them into group A (diltiazem gel) and group B (lateral internal sphincterotomy), with 50 patients in each group.

What were the key outcomes regarding healing and recurrence?

Healing rates at three months were reported as 82% for group A and 68% for group B. Recurrence at the reported follow-up period was 12% in group A and 2% in group B.

Sep 29, 2026

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