Anal fissures are linear ulcers in the anal canal, and can be very painful following defecation. A tear in the lower bowel that is resistant to healing typically causes fissures and this often leads to rectal bleeding. Typical treatments include surgery to reduce anal pressure or drug treatments to temporarily reduce pressure on the sphincter muscle and allow the ulcer to heal. As surgery may result in permanent sphincter disfunction causing fecal incontinence, drug treatment therapy is usually preferred.
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A number of topical solutions are used to treat anal fissures, including local, topical nitroglycerine, diltiazem, and locally injected botulinum toxin. The recommended treatment depends on the severity of the condition and the chronic nature of the problem.
Sildenafil citrate is approved for use as a treatment for erectile disfunction as an inhibitor of phosphodiesterase 5, and its use results in increased nitric oxide induced smooth muscle relaxation. Thus, it has been suggested that it may be effective in reducing anal sphincter hyperactivity in patients with anal fissures.
In a study involving 19 male and female patients with anal fissures, a topical cream containing 75 mg sildenafil was applied topically to the fissure. The study was conducted to test the results on the maximum resting anal sphincter pressures (MRP). All patients except one experienced a reduction of MRP of approximately 18 percent.
The cream was fast acting, and showed results in less than 3 minutes. On women, the drug acted more rapidly, showing results in about 80 seconds. Maximum relaxation of the sphincter muscle occurred within about one minute after application.
The topical sildenafil solution was well tolerated in all patients, with the most common side effects being mild or moderate itching and burning. Although more studies are required to prove the effectiveness of this cream, these results are promising.