Initially, medical therapy with special local ointment, stool softener and pain killers is attempted. If the fissure is not healing in 3 months and scar tissue is forming, then surgery is the only way to guarantee healing to the patient.
Normally, surgical cauterization (diathermy) under sedation is the only necessary treatment. Contextual sentinel polyp asportation is mandatory.
In more advanced cases, anal flap fashioning is necessary in order to make the fissure healing correctly. In the few cases where the muscle spasm is the main causative component, a little incision on the inner sphincter might be necessary, always taking utmost care to safeguard the continence. All the procedures are performed with minimally invasive techniques, allowing the patient to be operated in a Day Surgery setting, with less pain and quick return to daily activities.