Efficacy of homoeopathic medicines in the treatment of primary chronic anal fissures: A multicentric, double-blinded, randomized placebo-controlled trial

Chronic anal fissure (CAF) is defined as an ulcer that lasts at least six weeks due to chronic hypertonia of the anal sphincters and gets inflamed with scar tissue. Diagnosis is usually made from history and clinical presentation of pain could be a dominant symptom which is very intense in acute fissures but less severe in chronic cases. Often, they are associated with constipation, bleeding and mucous discharge from the anus. The recommended gold standard treatment modality for chronic fissures is lateral internal sphincterotomy (LIS) which often leads to complaints associated with stool continence. Alternatively, Chemical sphincterotomy (CS) with botulinum toxin, nitrates or calcium blockers is also recommended as non-invasive methods but the efficacy of such interventions are not well established. In homoeopathy, no good quality studies have been conducted on this condition to date, therefore this current trial is aimed to find whether empirically used medicines alter the outcome of treatment of chronic primary anal fissure. Homoeopathic medicines are clinically found to be safe and effective for the condition and the same evidence is to be confirmed within this trial.