This document discusses different treatment options for anal fissures, including sphincterotomy, glyceryl trinitrate (GTN), and botulinum toxin (Botox) injections. Sphincterotomy has the highest healing rates of 90-95% but carries a small risk of incontinence. GTN provides pain relief through its effects on the internal anal sphincter but has lower healing rates than sphincterotomy. Botox injections help relax the sphincter like GTN but have significantly lower healing rates and higher failure rates requiring reoperation compared to sphincterotomy. The best approach depends on the individual patient's history, symptoms, and preferences regarding risks and benefits of each option
![Nitroglycerin, Botox or Sphincterotomy for Anal Fissure ,[object Object],[object Object],[object Object]](https://image.slidesharecdn.com/anal-fissure-1228785671009724-9/85/Nitroglycerin-Botox-or-Sphincterotomy-for-Anal-Fissure-1-320.jpg)
