Anal Fistulas and Fissures Medication
- Author: Ingrid Legall, MD; Chief Editor: Robert E O'Connor, MD, MPH more...
Medication Summary
For treatment of anal fissures, no medication other than stool softeners is necessary to facilitate less painful passage of stool during acute disease. Anal fissures can cause a vicious cycle in which the patient, in anticipation of pain associated with bowel movement, resists the urge to defecate, causing stools to become larger and harder; more pain with defecation results.
Antibiotics may be necessary for treatment of anal fistulas, especially if the patient presents with systemic symptoms.
Intra-anal nitroglycerin is FDA approved for moderate to severe pain associated with chronic anal fissures and may be considered if conservative treatments of acute symptoms have failed.
Laxative/Bulking Agent
Class Summary
Psyllium facilitates easier passage of stools.
Psyllium (Fiberall, Metamucil, Konsyl, Reguloid, Natural Fiber Therapy)
Psyllium promotes bowel evacuation by forming a viscous liquid and promoting peristalsis.
Muscle Relaxants
Class Summary
Muscle relaxants are used for relief of anal spasm.
Nitroglycerin rectal (Rectiv)
Organic nitrate is indicated for moderate to severe pain associated with chronic anal fissures. It elicits internal anal sphincter relaxation and reduces sphincter tone and resting intra-anal pressure.
Diazepam (Valium, Diastat)
Diazepam is indicated for the relief of severe anal sphincter spasms.
Antibiotics
Class Summary
Antibiotic therapy must cover both aerobic and anaerobic gram-negative organisms.
Vancomycin (Vancocin)
Vancomycin is a potent antibiotic that is directed against gram-positive organisms and is active against Enterococcus species. It is useful in the treatment of septicemia, enterocolitis, and skin-structure infections. Vancomycin is indicated for patients who are unable to receive or have not responded to penicillins and cephalosporins or for patients with resistant staphylococcus infections. Creatinine clearance measurements are used to adjust the dose in patients with renal impairment.
Metronidazole (Flagyl)
Metronidazole is active against various anaerobic bacteria and protozoa. It appears to be absorbed into cells. Intermediate metabolized compounds are formed and bind DNA and inhibit protein synthesis, causing cell death. The antimicrobial effect may be due to production of free radicals.
Ampicillin and sulbactam (Unasyn)
This drug combination of a beta-lactamase inhibitor with ampicillin interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms.
Ticarcillin and clavulanate potassium (Timentin)
This drug combination of antipseudomonal penicillin plus a beta-lactamase inhibitor inhibits biosynthesis of cell wall mucopeptide and is effective during the stage of active growth. It provides coverage against most gram-positive, gram-negative, and anaerobic organisms.
Clindamycin (Cleocin)
Clindamycin is effective in the treatment of anaerobic bacteria. It has been shown to have superior effectiveness against streptococci and staphylococci. It continues to be effective against methicillin-resistant Staphylococcus aureus (MRSA).
Garcia-Aguilar J, Belmonte C, Wong WD, Goldberg SM, Madoff RD. Anal fistula surgery. Factors associated with recurrence and incontinence. Dis Colon Rectum. Jul 1996;39(7):723-9. [Medline].
North JH Jr, Weber TK, Rodriguez-Bigas MA, Meropol NJ, Petrelli NJ. The management of infectious and noninfectious anorectal complications in patients with leukemia. J Am Coll Surg. Oct 1996;183(4):322-8. [Medline].
Nordgren S, Fasth S, Hulten L. Anal fistulas in Crohn's disease: incidence and outcome of surgical treatment. Int J Colorectal Dis. Dec 1992;7(4):214-8. [Medline].
Kuehn HG, Gebbensleben O, Hilger Y, Rohde H. Relationship between anal symptoms and anal findings. Int J Med Sci. 2009;6(2):77-84. [Medline].
Oh C, Divino CM, Steinhagen RM. Anal fissure. 20-year experience. Dis Colon Rectum. Apr 1995;38(4):378-82. [Medline].
Nelson RL, Thomas K, Morgan J, Jones A. Non surgical therapy for anal fissure. Cochrane Database Syst Rev. Feb 15 2012;2:CD003431. [Medline].
Corno F, Marano A, Volpatto S, Mistrangelo P. [Topical use of glyceryl-trinitrate in the treatment of anal fissure]. Minerva Chir. Jun 2009;64(3):307-11. [Medline].
Vila S, Garcia C, Piscoya A, De Los Rios R, L Pinto J, Huerta Mercado J, et al. [Use of glycerol trinitrate in an ointment for the management of chronic anal fissure at the National Hospital "Cayetano Heredia"]. Rev Gastroenterol Peru. Jan-Mar 2009;29(1):33-9. [Medline].
Nitroglycerin rectal ointment (Rectiv) [package insert]. ProStrakan, Inc; 2011. [Full Text].
Khan JS, Tan N, Nikkhah D, Miles AJ. Subcutaneous lateral internal sphincterotomy (SLIS)-a safe technique for treatment of chronic anal fissure. Int J Colorectal Dis. Jul 21 2009;[Medline].
Mousavi SR, Sharifi M, Mehdikhah Z. A comparison between the results of fissurectomy and lateral internal sphincterotomy in the surgical management of chronic anal fissure. J Gastrointest Surg. Jul 2009;13(7):1279-82. [Medline].
Brisinda G, Cadeddu F, Mazzeo P, Maria G. Botulinum toxin A for the treatment of chronic anal fissure. Expert Rev Gastroenterol Hepatol. Dec 2007;1(2):219-28. [Medline].
Chung CC, Choi CL, Kwok SP, Leung KL, Lau WY, Li AK. Anal and perianal tuberculosis: a report of three cases in 10 years. J R Coll Surg Edinb. Jun 1997;42(3):189-90. [Medline].
Farquharson M. Haemorrhoids, fissures and anal fistulae. Trop Doct. Oct 2002;32(4):196-201. [Medline].
Isbister WH, Prasad J. Fissure in ano. Aust N Z J Surg. Feb 1995;65(2):107-8. [Medline].
Jonas and Scholefield. American Gastroenterology Association. 2004.
Print
