الفهرس 
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Abstract
Introduction : Chronic anal fissure is a common and painful condition and though frequently dismissed by the doctor as a minor complaint. It is in fact responsible for much discomfort so that its successful treatment results in a very satisfied and grateful patient. The majority of anal fissure occur in the posterior midline of the anal canal, but 10% of fissures in women and 1% in men occur in the anterior midline. Multiple or lateral fissures arouse suspicion of other diseases. Conclusion : The treatment of anal fissure has remained unchanged for over 150 years. Acute fissures are treated conservatively while chronic don’t respond to conservative treatment. Surgical treatment of fissures overcomes the sphincter spasm by forcible dilatation of the internal sphincter or sphincterotomy. Lateral sphincterotomy is the treatment of choice for chronic anal fissure as it has a lower recurrence rate and gives rapid relief of pain, with acceptable complications. Recently, there is strong evidence that nitric oxide plays a major role in mediating the relaxation of the internal anal sphincter by rapidly reducing the resting pressure in the upper anal canal. Topical glyceryl trinitrate in different concentration 0.2, 0.3,0.4, and 0.8% ointment was used for treatment of acute and chronic fissure as well as thrombosed external hemorrhoids. Many experience mild transient headache when using topical nitrate preparations, however there has been no report of incontinence during treatment. Medical (Chemical) treatment of chronic anal fissure using local 0.2% glyceryl trinitrate gives good results regarding pain relief and healing in most of the cases.