In cases of pre-existing or suspected fissure, use of a lubricating ointment (It is important to note that hemorrhoid ointment is contraindicated because it constricts small blood vessels, thus causes a decrease in blood flow, which prevents healing).In infants, frequent diaper change can prevent anal fissure. As constipation can be a cause, making sure the infant is drinking enough fluids (i.e. breastmilk, proper ratios when mixing formulas) is beneficial. In infants, once an anal fissure has occurred, addressing underlying causes is usually enough to ensure healing occurs. Treatment
Non-surgical treatments are recommended initially for acute and chronic anal fissures. These include topical nitroglycerin or calcium channel blockers (e.g. diltiazem), or injection of botulinum toxin into the anal sphincter.Other measures include warm sitz baths, topical anesthetics, high-fiber diet and stool softeners. Medication
Local application of medication to relax the sphincter muscle, thus allowing the healing to proceed, was first proposed in 1994 with nitroglycerine ointment,
and then calcium channel blockers in 1999 with nifedipine ointment,
and the following year with topical diltiazem. Branded preparations are now available of topical nitroglycerine ointment (Rectogesic (Rectiv) as 0.2% in Australia and 0.4% in UK and US), topical nifedipine 0.3% with lidocaine 1.5% ointment (Antrolin in Italy since April 2004) and diltiazem 2% (Anoheal in UK, although still in Phase III development). A common side effect drawback of nitroglycerine ointment is headache, caused by systemic absorption of the drug, which limits patient acceptability.
A prolonged treatment course is indicated, with patients usually requiring at least 4-6 months of treatment. Patients who are treated with larger doses of steroids require prophylaxis against pneumocystis jirovecii. Relapses may occur and are more likely to occur in severe disease or when steroids are tapered too soon or too quickly. Alternative or adjunct treatment options include macrolide antibiotics (due to anti-inflammatory properties), azathioprine and cyclophosphamide. References
External links

"Idiopathic Interstitial Pneumonias". Merck Manual Professional. May 2008.