The management of primary anal fissures is generally non-operative and includes increased dietary fibre, sitz baths, topical ointments and botulinum toxin injections. If these treatments are ineffective the patient will need a surgical referral. The third type of topical medication commonly prescribed for patients with anal fissures includes a topical anesthetic. These creams or ointments can help to numb the surrounding area, making the patient more comfortable. In the event that anal fissure ointments dont work, there are a few more treatment options available for those that wish. Topical ointments are non-invasive, meaning they are used on the skin. There are several types of topical ointments including analgesic ointments, anti-inflammatory ointments and anti-infective ointments, such as those that treat superficial infections of the skin like irritated areas and surface cuts. Topical medications topical steroids, such as creams or ointments containing 1 hydrocortisone, may help to relieve itching and irritation. The cream or ointment may be applied two or three times to the affected area each day. Topical capsaicin has been studied as an alternative to steroids for patients with chronic pruritus ani. Anal fissure ointment is a common treatment for rectal tears also known as anal fissures. Nitroglycerin ointment is a popular variety, but ointments containing zinc oxide or hydrocortisone also can be used. Zinc oxide ointment is sometimes prescribed to patients who are suffering from rectal itching. small amounts of mucus leak onto the skin of the lower anal canal causing maceration. It is hopeful thinking to consider that a topical preparation can compensate for the long-term frustration of a phenomenon as basic as the gastrocolic reflex. Common topical anal preparations include local anaesthetics, steroids and antibiotics. When seeking to relieve symptoms associated with anal fissures, non-surgical treatments are recommended initially for acute and chronic anal fissures. These treatment options usually include topical nitroglycerin or calcium channel blockers. Through topical ointments, the sphincter muscle can relax in order to stimulate the healing process. In this study the use of topical 2 per cent diltiazem ointment has been investigated as an alternative method of chemical sphincterotomy. Methods a prospective assessment of 71 consecutive patients with a chronic anal fissure treated with 2 per cent topical diltiazem ointment for a median duration of 9 (range 2--16) weeks was performed. Topical calcium channel blockers are thought to be about as effective as gtn ointment for treating anal fissures, and may be recommended if other medicines havent helped.