The management of chronic anal fissure and its symptoms, pain and occasional bleeding, is conservative to start with. We use glyceryl trinitrate or diltiazem cream perianally. If it is well tolerated (causes headache) should heal half of the fissures in six weeks time.

If these fail in some cases we use BOTOX injections.

Lateral internal sphincerotomy is the surgical option, which results in quick relief of symptoms and healing, but is usually reserved for those patients in whom the cream fails.