Anal fissure is a common problem, with several different modalities of treatment. Although the diagnosis and evaluation of fissure is not complicated, there are many different accepted treatments. Initial conservative measures focus on normalizing stool bulk and avoiding constipation. Medical treatment with nitroglycerine, calcium channel blockers, and topical anesthetics/steroids have proven efficacy, as does botulinum injection. The current evidence is not sufficient to label one of these options as the preferred treatment for anal fissure. Surgical sphincterotomy and anoplasty should be reserved for refractory cases.
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