<p>Anal fissure causes pain and bleeding during or after bowel movements, significantly impacting individuals’ quality of life. Current treatments aim to interrupt this cycle but have associated risks and limitations. The emergence of arginine, crucial for protein creation and nitric oxide (NO) production, presents an intriguing therapeutic avenue by the impact on reducing anal sphincter pressure and enhancing anoderm blood flow, due to its roles in vasodilation, anti-inflammatory responses, and collagen synthesis, which can promote wound healing and highlighting its potential as an alternative therapy. However, the effectiveness of oral supplementation remains debated, indicating the need for further elucidation of its mechanisms. Its multifaceted mechanisms can present an exciting avenue for nuanced treatments, urging further exploration to refine its role in chronic anal fissure management. This review comprehensively explores the therapeutic landscape of L-arginine in chronic anal fissure management, integrating recent research studies and clinical investigations.</p>