There are many patients who come to the clinic with anal fissures, and most of them are young women. Most of the patients have a question: Is surgery necessary for anal fissure? So let’s have a preliminary analysis of this question. Let us first revisit what an anal fissure is: an anal fissure is a small ulcer formed after a fracture of the skin layer of the anal canal below the dentate line. It is usually 0.5~25px long, shuttle-shaped or oval-shaped, mostly seen in young and middle-aged people, and most anal fissures are located on the posterior median line of the anal canal, but also on the anterior median line. The main symptoms of anal fissures are pain during defecation and blood in the stool, which can be large or small. The cause is related to a variety of factors, among which mechanical trauma during defecation caused by chronic constipation and dry stools is the direct cause of most anal fissures. There are also some pre-existing lesions in the anal canal that can lead to ulcers and thus fissures. Recently, it has also been suggested that increased pressure in the internal anal sphincter at rest is closely related to the development of anal fissures. The current clinical guidelines for the treatment of anal fissures are as follows: acute or incipient fissures can be treated with sitz baths and laxatives; chronic fissures can be treated with sitz baths, laxatives, and anal dilation; only those that do not heal for a long time, where conservative treatment is ineffective and symptoms are severe can be treated surgically. Non-surgical treatment of anal fissure is mainly to release the spasm of the sphincter, relieve pain, help defecation, interrupt the vicious cycle and promote local wound healing. For example, after defecation, use 1:5000 potassium permanganate warm water bath to maintain local cleanliness; take oral laxative or paraffin oil to loosen and lubricate the stool; increase drinking water and multi-fiber food to correct constipation and keep the stool open; after local anesthesia for anal fissure, the patient lies on his side, first use the index finger to dilate the anus and then gradually extend the two middle fingers to maintain dilation for 5 minutes. The dilation can release the spasm of the sphincter, expand the trauma and promote the healing of the fissure. For early simple anal fissures, methylene blue procaine injection can also be used as a long-acting anesthetic for local injection into the fissure, with the drug injected into the base of the fissure and surrounding tissues and gently massaged by the fingers. In addition, combined with Chinese medicine, there are also the following ways: 1. Internal treatment is based on Chinese medicine to identify and treat: ① Heat in the intestines. The representative formula is Cool Blood Dihuang Occasion Ma Ren Wan; ② Damp-Heat infusion, to clear heat and dampness as the treatment, available to stop pain as Shen Tang plus or minus; ③ Yin deficiency intestinal dryness, to nourish Yin, moisten intestines and pass stool as the treatment, available to increase liquid Tang plus or minus; ④ Blood deficiency intestinal dryness, to nourish Blood and nourish Yin, moisten intestines and pass stool, commonly used to moisten intestinal pill plus or minus. 2.Massage therapy Massage specific Tianshu acupuncture point can promote intestinal peristalsis, relieve constipation and alleviate the role of symptoms, applicable to the treatment of all stages of anal fissure, with certain curative effect. To sum up, it is not necessary to have surgery for anal fissure.