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Topical nitrates potentiate the effect of botulinum toxin in the treatment of patients with refractory anal fissure. Chronic anal fissures can be simply and effectively treated medically without the risk of incontinence associated with sphincterotomy. Internal anal sphincterotomy more effective than nitric oxide donors, botulinum A toxin—hemagglutinin complex, calcium channel blockers, or anal stretch. Simple measures are often effective for early fissures. Dysport is an alternative tolerable commercial formulation of botulinum toxin to Botox; however, the what is chronic anal fissure in dose needs attention as, in one study by Brisinda et al. The optimal treatment for anal what is chronic anal fissure is to induce a temporary reduction of anal canal pressure to promote healing of the fissure without permanently disrupting normal sphincter function. Eighty-eight patients 41 females, 47 males made up the study group.
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