The standard advice says a fissure heals with rest and patience. That sounds gentle, but it overlooks how targeted topical therapy changes outcomes. I treat fissure ointment as a first-line tool, not a consolation prize. Used correctly, it reduces pain fast, relaxes spasm, and supports healing while broader care addresses diet, bowel habits, and triggers.

Best Fissure Ointments Available in India

1. Shield Rectal Ointment

For acute pain and itching, I often begin with a multi-ingredient fissure ointment that soothes, numbs, and shields the wound. As Pristyn Care notes, Shield Rectal Ointment contains Allantoin for skin repair, Lidocaine for local anaesthesia, Hydrocortisone acetate for inflammation control, and Zinc Oxide for a protective barrier, with pricing around INR 73 for 15 g in India.

This combination covers the basics. The barrier reduces friction during bowel movements. The steroid calms inflamed tissue for a short course. The local anaesthetic lowers pain enough to break the spasm cycle. I advise conservative use of steroid components and reassess after a week if symptoms persist.

• Best for: acute pain, itch, low grade inflammation.

• Role: symptomatic relief while dietary and stool measures start working.

• Note: hygienic application matters for effect and safety.

2. Anovate Cream

Anovate uses a pragmatic trio: Phenylephrine to reduce congestion, Beclometasone as a mild steroid, and Lidocaine to numb pain. The blend helps when swelling and tenderness dominate. I keep application minimal and time bound because steroid overuse can thin skin.

• Best for: mixed pain and swelling around the fissure.

• Technique: cleanse, pat dry, apply a pea-sized amount with a gloved finger.

• Caution: stop if persistent burning or irritation develops.

I position this fissure ointment as a short bridge to high fibre intake and gentle stool softening. If bleeding or spasm persists, I escalate to a vasodilator based option.

3. Lignocaine Hydrochloride Gel

Lignocaine 2 percent gel is a straightforward anaesthetic. It blocks pain signals and reduces the dread of passing stool. That single effect can improve adherence to therapy. In acute fissures, analgesia can be decisive during the first week.

As the International Journal of Current Pharmaceutical Review and Research reported, roughly 95 percent of patients noted pain relief by week one, with healing rates rising from about 35 percent at one week to 60 percent by day 15 and full recovery by six months in the cohort.

• Strength: reliable, fast analgesia before bowel movements.

• Limitation: analgesia alone does not relax the internal sphincter.

• Tip: apply 5 to 10 minutes prior to toileting for maximal benefit.

I rarely use a lignocaine only fissure ointment as monotherapy for long. It pairs well with a vasodilator or barrier cream once pain is under control.

4. Anobliss Cream

Anobliss typically combines a local anaesthetic with wound healing and soothing agents. The goal is comfort plus mucosal repair. For patients who report stinging, I advise a smaller initial quantity and a test application. If tolerance is good, a twice daily schedule is reasonable.

• Best for: tender, superficial tears with significant stinging.

• Role: adjunct to fibre, hydration, and stool softeners.

This fissure ointment suits those who cannot tolerate stronger vasodilators initially. It also helps during travel when routines change.

5. Cremagel 2% (Diltiazem)

Diltiazem 2 percent gel is a calcium channel blocker used topically to relax the internal anal sphincter. By lowering resting pressure, it improves blood flow and eases spasm. The effect is mechanistic and directly relevant to healing physiology.

• Best for: chronic fissures with spasm and sentinel tag.

• Onset: gradual, with steady improvement over 2 to 3 weeks.

• Common effects: mild burning or a transient headache in some users.

For many adults, a diltiazem based fissure ointment becomes the primary agent after pain is controlled. It addresses the driver rather than only the symptoms.

6. Nitrogesic (Nitroglycerin) Ointment

Nitroglycerin ointment donates nitric oxide, which relaxes smooth muscle and lowers sphincter pressure. The pharmacology is well understood. The trade off is a higher rate of headaches. I advise starting with a tiny amount and titrating up.

• Best for: chronic fissures or recurrent episodes.

• Technique: apply within the anal canal using a measured fingertip.

• Counsel: headaches usually fade with dose adjustment or time.

When diltiazem is unavailable, a nitroglycerin based fissure ointment is an effective alternative. It requires careful patient education to maintain adherence.

7. Doctor Butler’s Hemorrhoid and Fissure Ointment

Though positioned for haemorrhoids, this multi component cream offers barrier protection, mild anaesthesia, and moisturising support. It can reduce friction and irritation around a fissure. I treat it as a supportive option rather than a primary vasodilator.

• Best for: dryness, friction, and minor bleeding with toileting.

• Role: adjunct layered after a vasodilator in chronic cases.

For travellers or those with sensitive skin, this fissure ointment can stabilise the perianal environment while definitive therapy works.

8. Sucral Ano Ointment

Sucralfate based ointments form a protective complex over mucosal defects. That film may reduce local irritation and provide a scaffold for epithelial repair. In practice, it can soften the edge of pain during recovery.

• Best for: fissures that sting with wiping or prolonged sitting.

• Use: apply a thin layer after cleansing, avoid over application.

I often pair sucralfate with a diltiazem or nitroglycerin fissure ointment to combine barrier and pressure reduction.

9. Tronolane Hemorrhoid Cream

Tronolane formulations focus on pain relief and itch control. While not designed specifically for fissures, the local anaesthetic component can support short term comfort. It should not replace a vasodilator in chronic disease.

• Best for: short bursts of pain control in acute flares.

• Limit: rotate off once a more targeted fissure ointment is in place.

Pain relief matters, but healing requires improved blood flow and less spasm. I keep that hierarchy clear when selecting products.

10. Rectinol Ointment

Rectinol is a classic combination product in India with soothing bases, mild anaesthetics, and protectants. It can settle irritation from wiping and reduce burning after bowel movements. As with other combination creams, I prefer time limited use.

• Best for: surface irritation and mild swelling.

• Plan: transition to a targeted fissure ointment if symptoms persist.

In recurrent fissures, I do not rely on such combinations alone. They are supportive while the root cause is addressed.

How Fissure Ointments Work and Their Key Ingredients

Calcium Channel Blockers (Diltiazem

Diltiazem reduces internal anal sphincter tone by blocking calcium influx in smooth muscle. Lower tone means less resting pressure and better perfusion. That facilitates granulation and re epithelialisation. In practice, I expect gradual pain reduction within two weeks.

• Typical use: 2 percent gel applied twice daily, thin layer.

• Advantages: good efficacy with fewer headaches than nitroglycerin.

• Consideration: mild local irritation can occur, usually transient.

A diltiazem based fissure ointment is often my first choice for chronic fissures. It targets the key physiological barrier to healing.

Nitric Oxide Donors (Nitroglycerin)

Nitroglycerin releases nitric oxide which activates guanylate cyclase in smooth muscle. The result is sphincter relaxation and improved blood flow. Headache is the notable adverse effect. A lower starting dose mitigates this for many patients.

• Typical use: pea sized amount, applied intra anally twice daily.

• Advantages: strong pressure reduction when tolerated.

• Consideration: avoid excess quantity to limit systemic absorption.

When used carefully, a nitroglycerin fissure ointment achieves outcomes comparable to diltiazem. The best agent is the one the patient can use consistently.

Local Anaesthetics (Lidocaine)

Lidocaine stabilises neuronal membranes and reduces pain transmission. The effect is fast and predictable. It is invaluable during the first days of an acute fissure when fear of pain leads to stool withholding.

• Use case: pre bowel movement application for comfort and confidence.

• Synergy: pairs well with vasodilators to support healing.

• Safety: avoid excessive area coverage to reduce systemic risk.

A lidocaine based fissure ointment is supportive care, not curative therapy. The distinction matters for planning.

Zinc Oxide and Healing Agents

Zinc Oxide offers a physical barrier and mild antiseptic action. Agents such as Allantoin promote epithelial repair. Combined, they reduce maceration and stinging. For fissures with surface irritation, these components provide needed protection.

• Best role: adjunct protection during acute healing.

• Technique: thin film application after gentle cleansing.

When patients ask for a gentle fissure ointment, I often choose a Zinc Oxide combination in the first week, then step up if needed.

Corticosteroids for Inflammation

Topical steroids reduce oedema and erythema around the fissure. Short courses can make sitting and toileting tolerable. Long courses risk skin thinning and delayed healing. I keep steroid containing fissure ointment use brief and targeted.

• Use window: usually 5 to 7 days for symptomatic control.

• Avoid: prolonged application or high frequency dosing.

Inflammation relief is helpful. But still, sphincter relaxation is the headline act for chronic fissures.

Natural and Ayurvedic Ingredients

Aloe, coconut oil, sesame oil, triphala, and yashad bhasma are frequently used in Ayurvedic preparations. Many provide emollient, soothing, or barrier properties. Some have mild antimicrobial effects. Evidence quality varies, so I present them as supportive care.

• Best role: moisturising, reducing friction, aiding comfort.

• Combine with: fibre, hydration, and a vasodilator fissure ointment if chronic.

For patients who prefer natural options, I suggest clear monitoring. If pain or bleeding persists, escalation is prudent.

Medical Treatments Beyond Ointments

Botulinum Toxin Injection Therapy

Botulinum toxin temporarily relaxes the internal anal sphincter by inhibiting acetylcholine release. The effect lasts about 2 to 3 months. That window often suffices for chronic fissures to heal when ointments have failed.

• Indication: non healing fissures despite correct fissure ointment use.

• Benefit: targeted pressure reduction without tissue division.

• Risk: transient leakage in a small fraction of patients.

For patients hesitant about surgery, Botox is a reasonable intermediate step. It is basically a timed pressure reset.

Oral Medications vs Topical Applications

Topicals deliver high local concentration with limited systemic effects. Oral agents such as calcium channel blockers act systemically and carry blood pressure considerations. I reserve oral medication for select cases with hypertension tolerance and close supervision.

• Topical advantage: local effect with minimal systemic load.

• Oral use: second line when topical agents are not tolerated.

When in doubt, a well chosen fissure ointment remains the safer starting point.

When Surgery Becomes Necessary

Lateral internal sphincterotomy divides a small portion of the internal sphincter to lower pressure. It has high healing rates and patient satisfaction in chronic fissures. The main concern is continence, which is excellent in most modern series.

• Indication: persistent pain or bleeding after optimal medical therapy.

• Expectation: rapid relief of spasm and improved blood flow.

• Counsel: individual continence risk assessment is mandatory.

When a fissure refuses to heal, surgery is not a failure. It is definitive therapy.

Combination Treatment Approaches

Real world care is layered. A vasodilator fissure ointment, pre movement lidocaine, fibre supplementation, and sitz baths work together. Add a stool softener during hard stool phases. Adjust each component based on response every 2 weeks.

• Acute plan: pain control plus barrier protection.

• Chronic plan: pressure reduction plus nutrition and bowel habit reshaping.

This modular approach reduces time to recovery and lowers recurrence risk. It respects physiology and daily life constraints.

Home Remedies and Lifestyle Changes for Anal Fissures

High-Fibre Diet Essentials

Fibre normalises stool consistency and volume. That reduces strain and protects the healing edge. Aim for a mix of soluble and insoluble fibre from whole foods. Add a psyllium husk supplement if intake is inconsistent.

• Targets: fresh fruit, vegetables, legumes, oats, and bran.

• Tactic: increase gradually to avoid bloating and cramps.

Diet is not optional. A fissure ointment cannot overcome repeated hard stools. The gut needs consistent inputs.

Sitz Bath Benefits and Technique

Warm water relaxes the sphincter, improves blood flow, and cleanses the area gently. I suggest a 10 to 15 minute soak after bowel movements and before bedtime. Keep the water warm, not hot.

• Technique: sit comfortably, knees slightly flexed, relax breathing.

• Optional: a pinch of salt for comfort, not as a disinfectant.

Sitz baths pair well with a vasodilator fissure ointment applied after gentle pat drying. Simple. Effective.

Proper Hydration and Stool Softeners

Hydration keeps stools soft. The bowel is sensitive to fluid intake and timing. A stool softener like docusate or a gentle osmotic agent can be used short term during recovery.

• Goal: easy, formed stool that passes without strain.

• Timing: softener at night often helps the morning routine.

I taper softeners as fibre and water habits stabilise. The aim is autonomous bowel regularity without dependence.

Ayurvedic Home Treatment Options

Warm sesame oil massage around the perianal skin can reduce dryness and friction. Aloe vera gel may soothe irritated edges. Triphala at bedtime is used traditionally for bowel regularity, though individual tolerance varies.

• Principle: gentle care and consistent habits over quick fixes.

• Combine with: a primary fissure ointment when symptoms warrant.

I make room for these preferences if objective progress continues. If not, therapy escalates.

Exercise and Pelvic Floor Physiotherapy

Moderate walking and lower body mobility work improve bowel motility. Pelvic floor physiotherapy helps those with paradoxical contraction or guarding. Biofeedback can retrain defecation dynamics in select patients.

• Routine: daily 20 to 30 minute walk, gentle hip mobility drills.

• Signal for referral: pain with attempted relaxation despite progress elsewhere.

Movement aids recovery and reduces recurrence. It complements any fissure ointment used during treatment.

Making the Right Choice for Fissure Treatment

Choosing the right fissure ointment is a clinical decision shaped by presentation and tolerance. Acute tears with severe pain benefit from a local anaesthetic layered with a barrier cream for a few days. Chronic fissures with spasm respond best to a vasodilator such as diltiazem or nitroglycerin. I prefer diltiazem for most due to tolerability.

Here is a concise way to decide.

Scenario	Preferred Approach
Acute fissure, high pain, recent onset	Lidocaine based fissure ointment pre BM, Zinc Oxide barrier post BM, start fibre and sitz baths
Chronic fissure with spasm	Diltiazem 2 percent fissure ointment twice daily, analgesic support as needed
Recurrent fissure, headaches with diltiazem	Nitroglycerin fissure ointment in minimal effective dose, counsel on headaches
Non healing after optimal topical therapy	Botulinum toxin injection or consider lateral internal sphincterotomy after assessment
Significant anxiety about pain	Structured plan: sitz, timed lidocaine, breathing cues, then apply vasodilator fissure ointment

Two final points matter. First, align the fissure ointment with the phase of disease. Second, treat the stool, not only the wound. That is how healing sticks.

Frequently Asked Questions

How long should I use fissure ointment for complete healing?

For acute fissures, 2 to 4 weeks is typical with reassessment at two weeks. Chronic fissures often require 6 to 8 weeks of a vasodilator fissure ointment. I end therapy once pain, bleeding, and spasm have resolved and bowel habits are stable for two consecutive weeks.

Can fissure ointments be used during pregnancy and breastfeeding?

Local anaesthetics and barrier creams are often used under medical guidance. Vasodilators such as nitroglycerin or diltiazem require individual risk benefit discussion. I prioritise fibre, hydration, stool softeners, sitz baths, and a gentle fissure ointment with obstetric input as needed.

What are the side effects of diltiazem and nitroglycerin ointments?

Diltiazem can cause mild burning or a headache that usually fades. Nitroglycerin can cause more prominent headaches, light headedness, or flushing. I advise small initial quantities, careful application, and prompt review if symptoms persist.

Is Botox injection better than ointments for chronic fissures?

Neither is universally better. A diltiazem or nitroglycerin fissure ointment heals many chronic cases without injections. Botox is appropriate when topical therapy fails or adherence is difficult. The choice depends on symptom duration, tolerance, and patient preference.

When should I consider surgery instead of continuing with ointments?

Consider surgery if pain and bleeding persist after 6 to 8 weeks of correct therapy, or if spasm remains severe. Recurrent fissures despite best practice also warrant surgical review. I refer earlier if quality of life is significantly impaired.

Can children use the same fissure ointments as adults?

Children often respond to conservative care with fibre, fluids, stool softeners, and sitz baths. Some fissure ointments may be used in adjusted quantities under paediatric guidance. I avoid vasodilators unless a specialist advises and monitors use.

How to apply fissure ointment correctly for best results?

Wash hands, cleanse gently, and pat dry. Apply a small, pea sized quantity using a gloved fingertip. For vasodilators, insert just inside the anal canal. Wait a few minutes before passing stool when using lidocaine. Consistency beats volume.

Are Ayurvedic treatments effective for anal fissures?

They can improve comfort and stool quality to an extent. I use them as adjuncts to fibre, hydration, sitz baths, and a targeted fissure ointment. If bleeding or pain persists, escalate to evidence based medical therapy without delay.

Key takeaways:

• A fissure ointment is most effective when paired with fibre, hydration, and bowel habit changes.

• Diltiazem or nitroglycerin treat the underlying sphincter spasm in chronic cases.

• Pain control matters, but healing follows pressure reduction and steady stool softness.

Anal fissure treatment works best when the plan is simple and consistent. Choose one primary fissure ointment, support it with the right habits, and review progress on a fixed cadence.