Efficacy of a combination of herbal gel versus topical diltiazem (2%) in chronic anal fissure healing: a randomized doubleblind clinical trial

Chronic anal fissure (CAF) is a common painful ailment that adversely affects quality of life. Nonsurgical treatments such as topical diltiazem are routinely administered to patients with CAF. However, diltiazem is associated with side effects such as headache and allergic reactions, which often lead to discontinuation of the treatment. The aim of this study was to determine the efficacy and safety of a topical Persian herbal remedy with analgesic, antiinflammatory and antiseptic properties versus topical diltiazem (2%) in CAF healing. In this randomized double-blind clinical trial, 70 patients with CAF were randomly divided into an intervention group receiving topical herbal medicine and control group receiving topical diltiazem (2%) for 6 weeks. Both groups were given lifestyle and dietary advice including adherence to a high-fiber diet, avoidance of spicy foods, use of a laxative (psyllium powder) in case of constipation, and taking sitz baths. Severity of pain, bleeding, and itching were measured at the first visit as well as the first, third, and sixth weeks of treatment. Wound healing and epithelialization were evaluated by anal examination. The treatment and follow-up period was 12 weeks; 6 weeks for assessing the effect of treatment and 6 weeks for examining treatment maintenance and evaluating the percentage of recurrence. The herbal medicine caused significant reduction in pain compared with diltiazem (P < 0.001). The herbal medicine had a significant effect in terms of wound healing at the end of the period (P < 0.001). Recurrence rate was lower in the intervention group (32%) than the control group (56%), though this difference was not significant (P = 0.323) Findings of this clinical trial suggest a higher efficacy of the combination herbal remedy versus topical diltiazem 2% in the management of pain and wound associated with CAF.