Comparative Efficacy of Topical Metronidazole and Diltiazem versus Diltiazem Alone in the Treatment of Acute Anal Fissure

Abstract

Background: Acute anal fissure (AAF) is a disease associated with intense perianal pain and secondary muscle guarding. Traditional treatment focuses on muscle relaxation, but recent evidence indicates that subclinical bacterial colonization and local inflammation play a major role in hindering tissue repair.

Objectives: The research was to see the difference in the clinical outcomes of 1 per cent Metronidazole and 2 per cent Diltiazem cocktail versus the classical 2 per cent of Diltiazem monotherapy.

Duration: Six months (28-07-2025 to 02-02-2026).

Methodology: The study was a randomized controlled trial conducted at the General Surgery Department of the Divisional Headquarters Teaching Hospital, Mirpur. Sixty adults (18 to 70 years) who had acute fissures were recruited. The combination treatment was given to Group A, whereas standard Diltiazem monotherapy was given to Group B. Healing, pain (assessed using a Visual Analog Scale), and rectal bleeding were observed over a period of more than 6 weeks during which patients received twice-daily applications. The level of statistical significance was p < 0.05.

Results: The combination therapy showed a 40% superior healing rate. Complete recovery was achieved by 86.7% in Group A compared to 46.7% in Group B (p = 0.001). Mean VAS scores in Group A dropped significantly to 1.23 ± 1.63, whereas Group B remained higher at 2.73 ± 1.76 (p < 0.001). Persistent bleeding was significantly lower in the combination group (3.3%) than in the control (30%).

Conclusion: It is much more effective to treat infection and inflammation with muscle spasms than to treat spasms only. Dual therapy is a better non-surgical standard of care that enhances patient safety and outcomes.

Key Words: Acute Anal Fissure, Chemical Sphincterotomy, Diltiazem, Fissure Healing, Metronidazole