Anal fissures are primarily treated with medication. It's traditionally a topical ointment applied three times daily for six-weeks. This allows the anal sphincter to relax and the overlying skin to heal on its own. This is effective for symptom management more than 80% of the time. Anal fissures can recur, and a repeat course of medication is effective therapy. If fissures are refractory to the ointment, our next step is injecting Botox® into the anal sphincter. This allows for prolonged relaxation of the anal sphincter and additional time for the tear to heal. Botox® cures approximately 70% of fissures that do not respond to medication therapy. Finally, if the previous measures fail, there are surgical options that can be explored.