An anal fissure is a split in the skin of the anus. This leads to a lot of anal pain particularly when the bowels open. There may be a little bit of bright red blood seen on the paper. Many heal rapidly. If they persist the treatment focuses on temporarily decreasing the squeeze power of the anus. This allows more blood to get to the split and this helps the split heal. The methods used include specific creams (Rectogesic, diltiazem ointment), Botox injection into the anus, or a controlled division of a very small part of the anal muscle.