Following conservative treatment failure:
- Glyceryl trinitrate or Diltiazem can be used. Maximum 8 weeks treatment only. Needs medical review if problem persists beyond this time.
- Botulinum A toxin was agreed by DTMMC for chronic anal fissure as an unlicensed indication.
Caution: Due to unit differences in the potency assay, unit doses for different brands of Botulinum A toxin are NOT interchangeable.