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Documented to be the best non-surgical option for prevention and healing of anal fissures. An anal fissure is a break or tear in the skin of the anal canal. Anal fissures may be noticed by bright red anal bleeding on toilet paper and undergarments, or sometimes in the toilet. If acute they are painful after defecation, but with chronic fissures, pain intensity often reduces. Anal fissures usually extend from the anal opening and are usually located posteriorly in the midline, probably because of the relatively unsupported nature and poor perfusion of the anal wall in that location. an anal fissure may cause one or more of the following symptoms a visible tear in the skin around your anus. Anal skin tags occur due to build-up of blood vessels and collagen in skin areas that are thick. This build-up is as a result of the skin trying to cope with tears, skin folds or anal fissures. Anal fissures what is an anal fissure? An anal fissure is a small painful tear in the skin that lines the anus. Similar to hemorrhoids, an anal fissure can occur while passing dry, hard or large stools, during constipation or prolonged straining of the bowel, during chronic diarrhea, or during childbirth. lateral internal anal sphincterotomy is far more effective (90) in healing anal fissure. There is no difference between closed and open sphincterotomy techniques. Atypical anal fissures may require biopsy to rule out infectious disease, inflammatory bowel disease, or malignancy. For patients with hypotonic anal sphincters, dermal advancement. Documented to be the best non-surgical option for prevention and healing of anal fissures.