Chronic anal fissures are a common disease and show a high recurrence rate even though after various treatment modalities have been applied. The lateral internal sphincterectomy is the most successful treatment modality, but is difficult to apply to aged patients or multiparous women due to postoperative fecal incontinence [1, 2]. In these cases, a stepwise approach of Diltiazem and Botox injection with an anal fissurectomy is a good alternative for reducing postoperative fecal incontinence [3]. However, the high treatment cost and the lengthy treatment time are two obstacles that need to be resolved, so pretreatment counseling and strict indications for the selection of such a treatment modality are essential.