Effect of Shock Waves Therapy on Chronic Anal Fissure

Design of the study: A prospective, randomized, blind, paired (right/left) comparison. Materials: Measurement tool: * healing of anal fissure, * Wexner Constipation Scoring System * anal pain intensity by means of a 10-point visual analogue scale (VAS) Therapeutic instruments: •. shock waves • topical application of 0.4% glyceryl trinitrate (GTN) ointment Methods: • Testing procedures: The assessment will be performed before commencing treatment, after 4 and 8 weeks of the treatment. • Treatment procedures: Patients will be assigned randomly into two groups equal in number: shock waves Group: twenty patients will receive the shockwaves on perianal area of for 4 weeks (3 sessions /week). control Group: twenty patients will receive the recommended routine medical treatment include topical application of 0.4% glyceryl trinitrate (GTN) ointment only..