Painless chronic anal fissure

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The jeopardy of minor flatus or fecal incontinence is important with intragroup anal sphincterotomy than with botulinum toxin. Topical nitroglycerin increases the peril of headache compared with internal anal sphincterotomy. Postsurgical fecal dissoluteness may be garbled with postsurgical leakage (a short-term unfavourable effect).
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Clinical Evidence Handbook: Chronic Anal Fissures - American Family Physician

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Chronic anal fissure: 2% topical diltiazem hydrochloride | Guidance and guidelines | NICE

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An anal fissure is a common and often painful question caused by a small tear or ulcer (open sore) in the lining of the anus (back passage). This can cause bleeding, local itching and pain with a bowel movement, which can be severe. When someone has an anal fissure the first treatments can include a high-fibre diet, laxatives and applying anaesthetic ointments to the affected area.
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