The doctor will likely inquire about your medical history and will conduct a physical examination as well as a slight examination of your anal region. The tear will usually be apparent. This is the only way to identify an internal fissure.

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An acute anal fissure is thought to be a tear that is a little like a paper cut. A fissure that has been chronically present is likely to show larger tears and fleshy growths inside or on the outside. 

Treatment:

If you can keep your stool soft, for example, increasing the intake of liquids and fiber the anal fissures will usually heal within a couple of weeks. Every day, especially after stool movements, taking a bath in warm water for between 10 and 20 minutes will help to relax the sphincter and promote healing.

If the symptoms persist the treatment is likely to be required.

Externally applied Nitroglycerin helps to improve blood flow through the fissure and promote healing and help to relax the anal sphincter. If other conventional treatments do not work, nitroglycerin will be considered to be the treatment of preference. It can cause severe headaches.

Blood pressure medications Anal sphincter could help relax, such as Cardizem or Procardia. These medications can be taken either by mouth or applied externally, and applied if nitroglycerin isn't effective or has significant adverse side effects.

Injection of botulinum toxin type A (Botox) paralyzes the muscles that are the anal sphincter and relaxing spasms.

The topical creams of anesthetic, like lidocaine hydrochloride (Xylocaine), can be useful in relieving pain.