Anal fissure is common, painful and often associated with increased tone of the anal sphincter.1 About 50% of acute anal fissures heal spontaneously or with conservative treatment (such as local anaesthetic cream and dietary measures).2 Those which persist and do not completely heal within 6 weeks are considered chronic and are traditionally treated by surgery to reduce the sphincter pressure.3 Apart from the associated risks and discomfort, surgery can cause incontinence. Topical application of glyceryl trinitrate (GTN) ointment to the anal rim temporarily reduces resting anal sphincter pressure and promotes healing of fissures whilst minimising the risk of incontinence. Here, we discuss the place of GTN ointment used for the treatment of idiopathic anal fissure in adults. We do not discuss the treatment of fissures secondary to other conditions (such as Crohn's disease or anal carcinoma) or following childbirth.
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