Abstract
Introduction: Anal fissure may be a common problem that causes substantial morbidity in otherwise healthy subjects. An anal fissure is probably going to be non-healing if the fissure persists beyond four weeks and is called chronic. Anal fissure management has rapidly progressed with vast sort of treatment options available but still, surgical management remains the mainstay. To study aetiology & management of chronic anal fissure. Materials & Methods: A prospective observational study was done on 107 patients coming to OPD in a tertiary rural hospital from February 2020 to February 2021 with age 18 years and above, patient/legally acceptable representative willing to give written informed consent, admitted with a diagnosis of chronic anal fissure. Pregnant and lactating women & anal fissures with systemic diseases were excluded. Patients were treated with either a medical or surgical approach and the response was noted. Data were collected from case records and analyses was done with the help of Microsoft Excel. Results: Mean age of patients was 43.1 ± 7.4 with a male to female ratio of 1.2:1. Nearly 80% of patients complained of chronic constipation and history of the passage of hard stools. Posterior wall location of the fissure is seen in more than 80% of patients. 49 patients received 0.2% GTN treatment 48.9% showed favourable responses. 83 patients received 2% Diltiazem treatment (including patients who failed and stopped 0.2% GTN treatment) 69.8% of patients showed positive outcomes. Surgical treatment showed nearly 100% cure rates. The maximum patient showed favourable outcomes at 8-10 weeks. Conclusion: Many patients who present with chronic anal fissure complains of chronic constipation with a history of the passage of hard stools. The posterior anal canal wall is the most common site. Medical management is the common initial option preferred by patients but with poor healing rates compared to lateral anal sphincterotomy which is associated with minimal complication and maximum efficacy.

Key words: Chronic fissure, constipation, diltiazem, glyceryl trinitrate, lateral anal sphincterotomy