COMPARATIVE EFFECTIVENESS OF CONSERVATIVE METHODS FOR ACCELERATING EPITHELIALIZATION IN ACUTE ANAL FISSURE

This prospective open-label comparative study evaluated the efficacy of various conservative treatments for acute anal fissure (AAF) in accelerating epithelialization and reducing pain. A total of 120 patients with symptom duration ≤6 weeks were randomized into four groups: control (hygiene only), dietary therapy (fiber-rich diet + psyllium), monotherapy with a sphincter relaxant (0.2% nitroglycerin ointment), and combined therapy (diet + nitroglycerin). The primary outcome was time to complete epithelialization; secondary outcomes included pain dynamics on the Visual Analog Scale (VAS) and incidence of chronic fissure. Results demonstrated that combined therapy achieved the shortest epithelialization time (10.5±1.5 days), which was significantly shorter than both monotherapy groups and the control (p<0.01). The combined regimen also produced the most pronounced pain reduction from day 3 onward and completely prevented the development of chronic fissure. Dietary modification and nitroglycerin alone improved outcomes but were inferior to the combined approach. In conclusion, the combination of dietary intervention and topical nitroglycerin represents the most effective conservative strategy for AAF, promoting faster healing, superior pain control, and prevention of chronicity.