Since conservative measures haven't worked, there are highly effective medical options available. \n\n**Prescription Ointments:** Topical calcium channel blockers (such as diltiazem or nifedipine gel) or nitroglycerin ointment relax the sphincter muscle, improving blood flow to promote healing.\n\n**Advanced Treatments:**\n- **Botulinum Toxin Injections:** Temporarily relaxes the anal sphincter muscle to allow the fissure to heal.\n- **Lateral Internal Sphincterotomy (LIS):** A minor, highly successful surgical procedure that permanently reduces muscle tension. It is considered the gold standard for curing chronic fissures.\n\nPlease consult a colorectal surgeon or gastroenterologist to discuss these targeted options for a permanent cure.