Introduction: The most frequent source of excruciating anorectal pain in adults is an anal fissure, which considerably increases the burden in coloproctology. Numerous treatment options are available, including topical nitrites, calcium channel blockers, injections of botulinum toxin, and sphincterotomy. This study set out to assess available strategies for managing chronic anal fissure. Methods: A thorough search was conducted to find randomised controlled trials contrasting different anal fissure treatments that were published between 2000 and 2020. The main result that was evaluated was healing eight weeks after the start of the treatment. Recurrence, intolerance to therapy, and problems were considered secondary outcomes. Results: There were found to be 2822 studies in total. Nine randomised controlled trials that satisfied predetermined criteria were found after duplicates and irrelevant studies were removed. There were 775 patients in all. At 8 weeks, the sphincterotomy group had a recovery rate of 95.13%, compared to 66.7% for botulinum toxin, 63.8% for nitrate, 52.3% for topical diltiazem, and 50% for topical minoxidil. The rate of recurrence was highest in individuals receiving injections of botulinum toxin (41.7%) and lowest in those receiving sphincterotomy (6.9%). There was a chance of developing lifelong incontinence with sphincterotomy, even though the overall number was minimal. Conclusion: This analysis of the randomised control data shows that sphincterotomy was much more effective in promoting healing than more conservative treatments. Although poorly tolerated in comparison to other therapies, topical nitrites had results comparable to those of injections of botulinum toxin. Sphincterotomy had benefits, but it also came with more risks, most notably persistent incontinence.