Anesthetics, Steroids and Calcium Channel Blockers

Anesthetics, Steroids and Calcium Channel Blockers

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Anesthetics, Steroids and Calcium Channel Blockers in Anal Fissure Treatment

Local anesthetic agents (Xylocaine, lidocaine) are frequently used and recommended (prescribed) by doctors for management of anal fissure. These agents are used topically (local administration as ointment) preferably before bowel movement to reduce pain during defecation. Applied 5-15 minutes before defecation these agents are effective in reducing pain and improve symptoms of anal fissure. Sometimes small quantity of steroid can be added (combined) with the local anesthetic ointment. Steroids act by reducing inflammation (the site surrounding the tear or fissure is invariably inflamed) in the anoderm where it is torn. The steroids should be used less than two weeks and long term use of steroids avoided, as use of steroids beyond two weeks may cause atrophy of anoderm, which make it prone to injury and trauma and cause tear (the patients of anal fissure generally have some kind of anatomical abnormality and atrophy of anoderm makes the patients more susceptible to develop anal fissure).

Calcium channel blockers such as nifedipine, diltiazem are used in management of anal fissure. Ointment containing calcium channel blockers helps in relaxation of muscles of anal sphincter. Calcium channel blockers block the entry of calcium ions (Ca+2) into the muscle cells and prevent contraction of muscles, which cause relaxation of muscle and reduce pain. By the same mechanism calcium channel blockers cause dilatation of blood vessels of anoderm (location where anal fissures develop) and increase blood flow and speed healing of anal fissures. Nifedipine (Adalat) ointment 2% applied to the anal canal and anoderm cause relaxation of anal sphincter and causes fewer side effects in compare to nitroglycerine. Use of nifedipine or other calcium channel blocker as ointment has been shown to cause healing of anal fissure in approximately two-third of chronic anal fissure patients, but the healing rate is much higher in patients with acute anal fissure.

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