Symptomatic chronic posterior anal fissure

Anal fissure is a painful linear mucosal tear situated in distal anal canal extending from just below dentate line to the anal verge [1]. Complete healing was defined with complete epithelialization of ulcer bed at visual assessment and no pain. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4. The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. A comparison of injections of botulinum toxin and topical nitroglycerin ointment for the treatment of chronic anal fissure. Isosorbide dinitrate as a nitric oxide donor has been tried to produce chemical sphincterotomy but it causes headache as a prominent side effect.
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Chronic anal fissure: 2% topical diltiazem hydrochloride

If someone has a chronic fissure, it is thought that the reason it has not healed is that the ring muscle sphincter that goes around the anus back passage has become so tense that the flow of blood to the lining of the anus is reduced. This improvement in the blood supply helps to heal the fissure, and the weakening of the sphincter is also believed to reduce the potential for recurrence. Some people with anal fissures may need medication or, occasionally, surgery. Cleveland Clinic. World Journal of Gastroenterology. The pain from the sphincterotomy is usually mild and is often less than the pain of the fissure itself.
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Anal fissure - Symptoms and causes - Mayo Clinic

Canadian Journal of Surgery. British Medical Journal. Surgical operations involve a general or regional anaesthetia. Archived from the original Reprint on 29 January
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Anal fissure

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Description: In infants, once an anal fissure has occurred, addressing underlying causes is usually enough to ensure healing occurs. Accessed Oct. Retrieved 20 July In older adults, anal fissures may be caused by decreased blood flow to the area. Brown AY.

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