Nitroglycerine in Treatment of Anal Fissure

Nitroglycerine in Treatment of Anal Fissure

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Nitroglycerine in Treatment of Anal Fissure

Nitroglycerine (glyceryl trinitrate) is used for treatment of anal fissure, as it has muscle relaxant property. Spasm of internal anal sphincter muscles, which reduce blood flow to the internal anal sphincter muscles possibly play an important role in causation of anal fissure as well in healing of anal fissures and the quality of nitroglycerine (muscle relaxation), is used in management of anal fissure. Ointment containing nitroglycerine is used and found to be effective in treatment (healing) of anal fissures.

How nitroglycerine acts in anal fissure treatment?

Nitroglycerine causes relaxation of the internal anal sphincter (the muscles of the sphincter) and as a result reduces the tone of sphincter and thereby reduces resting pressure of the anus. When ointments containing nitroglycerine are applied to the anal canal it (nitroglycerine) diffuses into the muscles of the anal sphincter through anoderm and relaxes the muscles, which in turn reduce pressure in the anal canal. Relaxation of sphincter muscle prevents spasm and promotes healing of anal fissure by increasing blood flow. As nitroglycerine is highly lipid soluble it can easily penetrate (diffuse) through cells as cell walls are made of lipids.

What are the disadvantages (side effects) of nitroglycerine?

The side effects of nitroglycerine are common and commonly responsible for limitation of the use of this drug. The side effects of nitroglycerine ointment are mostly due to absorption of the drug to systemic circulation and include headache due to dilatation of blood vessels of head, lightheadedness, flashing etc. The side effects are usually minor and go away by itself after use of several days.

To prevent side effects nitroglycerine should be used in small amount which should be applied to a cotton-tipped swab and inserted into the anus only for the depth of the cotton-tipped portion of the swab. Do not apply ointment outside anus which will be absorbed and produce side effects but not reach the anoderm where it will act. Bathing with warm water causes dilatation of blood vessels and increase absorption of nitroglycerine, which is why it should not be applied within 30 minutes after a warm water bath.

To prevent/reduce side effects, nitroglycerine should be applied at bed time, especially at the beginning to prevent fall due to lightheadedness. Caffeine can also reduce headache. if side effects become troublesome nitroglycerine should be stopped.

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