Brief Answer: Surgical approach is used for chronic anal fissure Detailed Answer: Hello sir and welcome. Thank you for writing to us. Treatment of chronic anal fissure include the following approaches: -Conservative: a. Steroid creams to be applied locally to the anal region. This helps in reducing swelling and also provides relief from pain to quite an extent b. Nitroglycerin to be applied locally to the anal region. This helps in improving blood circulation and also relaxes the tension in the muscles c. Blood pressure medications are prescribed to help relax the muscles around the anal region, especially the anal sphincter d. Injections containing botulin help in relaxing the muscles in and around the anal region -Surgical approach: This approach is especially considered in chronic anal fissure patients, wherein a part of the anal fissure is excised and removed in order to relax the sphincter and reduce swelling I hope you find my response both helpful and informative. Please feel free to write back to me for any further clarifications, I would be more than happy to help you. Best wishes.

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