Background <p>Anal fissure is a&#xa0;very common, painful condition in coloproctological practice.</p> Objectives <p>Recommendations for nonsurgical treatment of primary anal fissure.</p> Materials and methods <p>Literature search, analysis of guidelines, and expert recommendations.</p> Results <p>Chronic fissures are differentiated from acute fissures based on the duration of symptoms (&gt; 6–8&#xa0;weeks) and secondary changes, like a&#xa0;sentinel skin tag or hypertrophied anal papilla. For both, treatment is primarily nonsurgical, but for chronic fissures, surgical treatment can be performed as an alternative. Nonsurgical treatment consists of stool regulation and topical application of calcium channel antagonists or nitrates to reduce anal sphincter tone. Anal dilatation or the application of topical local anesthetics can also be performed. If conservative treatment fails, botulinum toxin injection into the sphincter can be used as an alternative to surgery for chronic fissures.</p> Conclusions <p>Chemical sphincterolysis using topical ointments is the primary nonsurgical treatment of fissures and often avoids surgical treatment. Surgery is indicated in cases of unsuccessful nonsurgical treatment, infectious complications such as fistulas, or in cases of pronounced secondary changes.</p>