BACKGROUND: The aim of this study is to compare the ability of three treatments in patients with anal fissure, sphincterotomy, nitroglycerin ointment and combination of gel xylocaine and lactulose.METHODS: Ninety adults divided in three groups of 30 patients each group, received one of the three treatments in a 3-year interval (2007-2009) and the follow-up was for 2 months. Group A received nitroglycerin ointment, Group B underwent sphincterotomy and Group C received gel xylocaine and lactulose.RESULTS: Concerning pain, after treatment 60% of patients in Group A did not complain of pain, 20% had transient pain, another 10% moderate pain and the remaining 10% had severe pain. In Group B, 95% of the patients had no pain and only 5% had mild, transient pain. In Group C 60% of the patients had moderate pain and the other 40% suffered from severe pain. Concerning fissure healing, in 60% of the patients of Group A, the fissure was healed. In Group B fissure healed in 93.3% and in Group C only in 16.6% of the patients.CONCLUSION: The "gold standard" for anal fissure treatment is the lateral internal sphincterotomy and that each one of the three methods has its advantages and disadvantages.