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Hello der Externally applied nitrogylcerin, to help increase blood flow to the fissure and promote healing, and to help relax the anal sphincter. Nitroglycerin is generally considered the medical treatment of choice when other conservative measures fail. Side effects may include headache. Steroid creams, to help relieve discomfort. Botulin toxin type A (Botox) injection, to paralyze the anal sphincter muscle and relax spasms. Consult surgeon for further evaluation and treatment.