Novel Compounded Medications for Anal Fissure Pain

What is Anal Fissure?

An Anal Fissure is a small tear in a thin, moist tissue (mucosa) that lines the anus. Fissures result from the stretching of your anal mucosa beyond its normal capacity. This often happens when stools are hard due to constipation. Once the tear happens, it leads to repeated injury. The exposed internal sphincter muscle beneath the tear goes into spasm. This causes severe pain. The spasm also pulls the edges of the fissure apart, making it difficult for your wound to heal. The spasm then leads to further tearing of the mucosa when you have bowel movements. This cycle leads to the development of a chronic anal fissure in approximately 40% of patients.

Compounded Treatment Options:

Chronic recurring wounds such as Anal fissures are often refractory to treatment with commercially available medications. Custom compounded formulations that include drugs proven effective in off label use but safe may achieve therapeutic goal. Two such agents are (i) Nifedipine, a calcium channel blocker, exhibits antioxidant properties. It increases collagen accumulation and fibroblast proliferation by promoting nitric oxide production, the effects of which enable healing of dermal wound. Nifedipine must be used with caution in patients with liver dysfunction (ii) Pentoxifylline, a synthetic dimethylxanthine derivative, induces a decrease in local elastase and fibrin deposits, procollagen synthesis, procollagen ribonucleic acid levels and level of nuclear factor-1 and inhibits collagen synthesis by dermal fibroblasts, all of which promote wound healing. A&O Compounding has compounded formulations specifically designed by their formulation specialists that incorporate such agents for example Nifedipine 1%/Pentoxifylline 1% in White Petrolatum.