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Abstract
Summary Anal fissure is a cut or a crack in the anal canal or anal verge that may extend from the mucocutaneous junction to the dentate line. It may occur at any age. It can be acute or chronic.
The cause of anal fissure has been long debated. Trauma to the anal canal secondary to the passage of a hard stool is believed to be a common initiating factor.Many theories have been reported to explain the development of anal fissure and pain associated with it as: Trauma, anatomic configuration, internal anal sphincter dysfunction, and ischemia Physiologic studies using ambulatory manometry have confirmed the presence of sustained resting hypertonia in fissure patients. Some of the anterior fissures occurring in women result from childbirth.
The majority of fissures occur in the posterior midline of the anal canal, multiple or lateral fissures may have other causes, such as Crohn’s disease, ulcerative colitis, tuberculosis, and infection with the human immunodeficiency virus (HIV) or syphilis.
The cardinal symptom of anal fissure is pain in the anus during and after defecation. The pain is very agonizing to the patient it is described as a sharp, cutting, or tearing sensation during and after passage of stool.
Subsequently, the pain may be less severe and may be described as aburning or gnawing discomfort that may persist from a few minutes to several hours. Bleeding is very common with fissure-in-ano but is notinvariably present. The blood is bright red and usually scant in amount. In addition peruritus ani may accompany up to 50% of cases.
Treatment of acute fissure-in-ano is based on breaking the cycle of a hard stool, pain, and reflex spasm. This result often can be accomplished with simple measures such as warm baths , ingestion bulkforming foods, anesthetic ointments and different pharmacologic therapies as glyceryl trinitrate, isosorbide dinitrate, calcium channel blockers such as diltiazem, or nifedipine and botulinum toxin that results in chemical denervation of the muscle.
The surgical treatment of anal fissure include manual dilatation, fissurectomy, posterior and lateral sphincterotomy and covering of the fissure The drawbacks of the surgical intervention is to cause permanent alteration in the control of gas, mucus, and occasionally stool.
Recently, great interest in therapeutic effects of Jojoba oil was shown. In (1997), Amin et al. prove the efficiency of Jojoba oil in the treatment of recurrent aphthous ulceration Amin et al., 1997). In 2001, El-Mogi et al. showed that Jojoba oil is as effective as corticosteroid in the treatment of napkin dermatitis (Mougi et al., 2001).
Jojoba oil is awaxy product extracted from seeds of jojoba shrubs.
Jojoba oil is proved to have anti-inflamatory, anti-microbial effects and considered to be non irritant when applied to both intact and abraded skin. It is non toxic and non carcinogenic. As inflamatory reaction is thefirst pathological change in the pathogenesis of anal fissure and its progress lead to its chronicty, this encouuraged the use of Jojoba oil in the treatment of acute anal fissure (Sobhy and Mohamed, 1997).
In this study we evaluate the efficacy of Jojoba oil versus Glyceryl Trinitrate in the treatment of patients with acute anal fissure.
200 patients were included in this study and were divided randomly into tow groups:Group І: Included 100 patients who were treated by Jojoba oil (suppositories) twice daily fore 2-4 weeks.
Group П: Included 100 patients who were treated medically by G.T.N 0.2% twice daily fore 2-4 weeks.
All patients were submitted to full history taking, examination: general abdominal examination and Local (Ano-rectal) examination .All patients in both groups were followed up at one week intervals for 4 weeks and followed up every month for 3 months then followed up after 6 months.
Concerning the tolerability, JLW suppositories are tolerable, easily and safely applied and it does not evoke side effects. While headache occurred in 20% and hypotension occur in 5% with GTN.
In the present study JLW suppositories showed 97 %healing rate at 2-8 weeks of treatment, in comparison to 79% with GTN (applied twice daily) at 12 weeks.