Calcium channel blockers that are applied directly to the anus have also proved useful in treating some people with anal fissures. Topical calcium channel blockers work by relaxing the sphincter muscle and increasing blood supply to the fissure. Topical diltiazem cream versus botulinum toxin a for the treatment of chronic anal fissure a double-blind randomized clinical trial. These may include a medicated cream (to help heal the fissure), a topical muscle relaxant (to relax the anal muscles), an anesthetic ointment (to reduce pain, if pain interferes with having a bowel movement), or nitroglycerin or calcium channel blocker ointments (to relax the anal muscles and increase blood flow to the region, promoting healing). Chronic anal fissures (present for 6 weeks or longer), and associated pain, may be treated with glyceryl trinitrate rectal ointment 0. 2 unlicensed (available from special-order manufacturers or specialist importing companies). Limited evidence suggests that the strength used does not influence the effectiveness, but that the higher strength potentially. Anal fissures can be very painful but there are several treatment methods that are available to provide sufferers with relief. Currently, there are at least three main types of anal fissure ointments that are commonly prescribed to assist those suffering from this condition. The goal of treatment is to relieve pain and discomfort, and heal the torn lining. Acute anal fissures -- the ones that dont last longer than 6 weeks -- are common and usually heal on their own. The treatment of anal fissure breaks the cyclic anal sphincter spasm, prevents tearing of the anal mucosa, and promotes healing of the fissure. The majority of anal fissures are treated medically, which is the topic of this discussion 1,2.