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Documented to be the best non-surgical option for prevention and healing of anal fissures. Other causes of fissures are anal cancer, crohns disease, leukemia as well as many infectious diseases including tuberculosis, viral infections (cytomegalovirus or herpes), syphilis, gonorrhea, chlamydia , chancroid (hemophilus ducreyi), and human immunodeficiency virus (hiv). Hiv-associated ulcers must be distinguished from idiopathic anal fissures in hiv-positive patients and from other sexually transmitted diseases that cause anogenital ulcers as the treatments differ. Keywords hiv-associated ulcer, differential diagnosis, treatment. Older adults are also prone to anal fissures due to decreased blood flow in the anorectal area. An anal fissure is a cut or a tear in the thin, delicate lining of your anus. The tear often exposes the muscle around the anus, called the anal sphincter. Primary anal fissures are usually singular and occur in the posterior midline of the anus, although a few cases may be seen in the anterior midline (especially in women). Secondary anal fissures may have an irregular outline, be multiple, or occur laterally. Documented to be the best non-surgical option for prevention and healing of anal fissures.