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Advancement anal flaps involve taking healthy tissue from another part of your body and using it to repair the fissure and improving the blood supply to the site of the fissure. Adults whose anal fissure has markedly improved but not fully healed should be advised to continue treatment (including rectal gtn ointment) and be reviewed in a further 68 weeks, or referred to a general or colorectal surgeon. For people with secondary anal fissure, when to review will depend on the underlying condition. these may include a medicated cream (to help heal the fissure), a topical muscle relaxant (to relax the anal muscles), an anesthetic ointment (to reduce pain, if pain interferes with having a bowel movement), or nitroglycerin or calcium channel blocker ointments (to relax the anal muscles and increase blood flow to the region, promoting healing). In approximately 90 of patients the anal fissure is located in the posterior midline. It is hypothesised that this predilection for the posterior midline may occur because this portion of the anal canal is poorly perfused. 7, 8 anterior anal fissures affect approximately 10 of patients and may have a different pathophysiology. They are associated with younger, mostly female, patients often. anal fissure ointment ingredients to look for the best and most effective anal fissure ointments are made with natural ingredients including herbs, minerals, and amino acids that promote pain releif and healing. Nitrate ointment your doctor may prescribe one of these to help raise blood flow to the anal canal and sphincter, which helps fissures get better faster. an anal fissure is a small tear or crack in the lining of the anus. If you experience severe pain or bright red bleeding during or after bowel movements, you may have an anal fissure. Chronic anal fissures (present for 6 weeks or longer), and associated pain, may be treated with glyceryl trinitrate rectal ointment 0. 2 unlicensed (available from special-order manufacturers or specialist importing companies). Limited evidence suggests that the strength used does not influence the effectiveness, but that the higher strength potentially.