**4. Non-operative management**

Usual recommendations for acute anal fissure include increased fiber and fluid ingestion, the use of local anesthetic ointments, warm daily sitz-bath, and stool softeners. Although almost half of the acute fissures heal with these conservative

treatments, the success rate is as low as 30% in chronic fissures [10–12]. Given the cost-effectiveness and potential risk of incontinence with surgery, international guidelines still recommend topical and botulinum toxin injection as first-line therapy.
