La recherche THD a créé Levorag emulgel, une crème adjuvante pour le traitement des fissures anales. Levorag permet de traiter les fissures anales de manière simple et pratique, sans recourir à des thérapies ou à des interventions invasives.
To treat sore skin, use the measures described in our Anal Irritation and Itching section.Most anal fissures go away with time but they can return if your constipation persists. If needed, they can be treated with high-fibre diets, or nitroglycerine or diltiazem ointment. If particularly severe, Botox injections can be used.
Diltiazem Topique Et Fissures Anales
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Transrectal ultrasound guided biopsy (TRUS-Bx) of the prostate is an established method for the diagnosis of prostatic cancer. The procedure is most commonly performed on an out-patient basis. It is an invasive procedure and is associated with pain thus requiring some form of analgesia (1,2). The pain associated with the procedure has two main causes, first the insertion of the transducer of the ultrasound into the rectum and second the pain due to insertion of the biopsy needle into the prostate (3,4). Numerous methods and agents have been tried in the past to decrease this pain. These can range from topical agents, oral agents, inhalational agents, injections, etc. Topical, intrarectal application of lignocaine is a commonly used modality for this procedure as it anaesthetises the rectal mucosa and the prostatic nerves. Periprostatic nerve block (PPNB) with lignocaine infiltration is now being promoted as the standard form of anaesthesia for this procedure. However, periprostatic injection of lignocaine which is given bilaterally to cause nerve block may itself be associated with significant pain and can make the whole procedure uncomfortable for the patient (5). PPNB is ineffective in decreasing the pain associated with the insertion of the transducer of the ultrasound into the rectum. It has been found in various randomized trials that the pain of insertion of probe is actually the most painful part of this procedure (6,7). Relaxing the anal sphincter may help reduce this pain. Theoretically, combining a drug which provides analgesia (e.g. topical lignocaine) with a drug that relaxes the anal sphincter can provide optimum pain control during TRUS-Bx of the prostate. Diltiazem and nitroglycerine have been used topically to decrease sphincter tone in patients with anal fissures (8,9). Thus, these drugs may help decrease the pain of TRUS-Bx of the prostate. We, in this study, evaluated and compared the efficacy and safety of the topical application of diltiazem with nitroglycerine in controlling the pain associated with different stages of the prostatic biopsy.
Diltiazem and nitroglycerine have been topically used in the treatment of anal fissures. They relax the anal sphincter, decrease the pain and promote healing of the fissure (8,9). They are commonly used drugs for this indication and are easily available. The notion that this action of these drugs can be of use during the prostate biopsy led to their evaluation in the present study. We used lignocaine gel which can block the periprostatic nerves and thus decrease the pain of needle insertion and nitroglycerine/diltiazem which relax the anal sphincter thus decreasing the pain due to insertion of the probe. Though there are a few studies available which have used nitroglycerine, ours is the first study that evaluates the efficacy and safety of diltiazem and also compares it with nitroglycerine (6,22). Our study also addresses the issue of recall bias which has been often quoted as an issue in the previous studies as pain scores were assessed at each step of the procedure.
Diltiazem is a benzothiazepine derivative with antihypertensive and vasodilating properties. Approved in 1982 by the FDA, it is a member of the non-dihydropyridine calcium channel blockers drug class. It works through various mechanisms of action, but it primarily works by inhibiting the calcium influx into cardiac and vascular smooth muscle during depolarization.12 Compared to dihydropyridine drugs, such as nifedipine, that preferentially act on vascular smooth muscle and verapamil that directly acts on the heart muscle, diltiazem displays an intermediate specificity to target both the cardiac and vascular smooth muscle.8 Being a potent vasodilator, diltiazem is used clinically as an antihypertensive, anti-arrhythmic, and as an anti-anginal agent 9 for the management of cardiovascular conditions such as hypertension, chronic stable angina, atrial fibrillation, atrial flutter. Apart from its main FDA-approved indications, diltiazem has also been used for numerous off-label indications, such as anal fissures (in topical formulations), migraine prophylaxis, pulmonary hypertension, and rest-related cramps in the lower extremities.9 Typically available in extended-release oral and intravenous formulations, diltiazem is marketed under various brand names with Cardizem and Tiazac being the most common ones.
Another medicine which works in a similar way is diltiazem cream. This is not currently licensed for anal fissures but specialists may use it for this. The National Institute for Health and Care Excellence (NICE) has examined the evidence on its use. Diltiazem cream seems effective and less likely to cause headaches than glyceryl trinitrate.
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