A COMPARATIVE STUDY OF TOPICAL NIFEDIPINE AND 2% DILTIAZEM GEL LOCAL APPLICATION IN THE TREATMENT OF FISSURE-IN-ANO

Background: Anal fissure is a common anorectal disorder characterised by severe pain during defaecation, bleeding, and internal anal sphincter spasm. Conservative treatment using topical calcium channel blockers offers an effective, non-invasive alternative to surgery. Objectives: To compare the efficacy and safety of 0.3% nifedipine versus 2% diltiazem gel in the non-surgical management of fissure-in-ano. Methods: This prospective observational study was conducted over 18 months at a tertiary care centre. A total of 100 adult patients with primary anal fissure were enrolled and randomly assigned into two groups via the SNOSE method. Group A received topical 0.3% nifedipine; Group B received 2% diltiazem gel. Pain severity (VAS), healing response, adverse effects, and quality of life (WHOQOL-BREF) were assessed at 1 and 4 weeks. Data were analysed using SPSS v26, with p< 0.05 considered statistically significant. Results: Both treatment groups showed statistically significant improvement in pain scores and bleeding (p = 0.000). Nifedipine demonstrated faster symptom relief, while diltiazem showed better tolerability. Minor adverse events included headache (3%) in the nifedipine group and dermatitis (2%) in the diltiazem group. Quality of life improved markedly in both groups. Conclusion: Both 0.3% nifedipine and 2% diltiazem gel are effective and safe for managing fissure-in-ano. Nifedipine may be preferred for faster relief, while diltiazem may be favoured in patients sensitive to side effects.