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according to the following reference text delimited in ### ### Anal fissure is an ulceration of the anoderm in the anal canal. Its pathogenesis is due to multiple factors: mechanical trauma, sphincter spasm, and ischemia. Treatment must address these causative factors. While American and British scientific societies have published recommendations, there is no formal treatment consensus in France. Medical treatment is non-specific, aimed at softening the stool and facilitating regular bowel movements; this results in healing of almost 50% of acute anal fissures. The risk of recurrent fissure remains high if the causative factors persist. If non-specific medical treatment fails, specific medical treatment can be offered to reversibly decrease hypertonic sphincter spasm. Surgery remains the most effective long-term treatment and should be offered for cases of chronic or complicated anal fissure but also for acute anal fissure with severe pain or for recurrent fissure despite optimal medical treatment. Surgical treatment is based on two principles that may be combined: decreasing sphincter tone and excision of the anal fissure. Lateral internal sphincterotomy (LIS) is the best-evaluated technique and remains the gold standard in English-speaking countries. Since LIS is associated with some risk of irreversible anal incontinence, its use is controversial in France where fissurectomy combined with anoplasty is preferred. Other techniques have been described to reduce the risk of incontinence (calibrated sphincterotomy, sphincteroplasty). The technique of forcible uncalibrated anal dilatation is no longer recommended. Anal fissure (AF) is an ulcer situated in the mucosa and the lower part of the anal canal from the anoderm up the dentate line. Clinical history and physical examination help to differentiate AF from hemorrhoidal disease, anoperineal Crohn's disease, various sexually-transmitted infections, and fissure due to underlying cancer. AF is the second most common reason for proctologic consultation after hemorrhoidal disease. It occurs more commonly in young adults with similar incidence in either sex. Its occurrence is less common beyond age 65 when other associated diseases must be considered. It is particularly common after childbirth affecting 15% of women. Anal fissure is considered acute when it is of recent onset (less than six weeks), and chronic if it has been present for a longer period, taking on a characteristic aspect that includes perianal skin tag, fibrotic edges, and a proximal papilla. A fissure may cause severe pain or be essentially asymptomatic depending on the degree of anal sphincter spasm. There is often associated low volume rectal bleeding. Secondary reflex constipation is very common due to the fear of pain associated with bowel movements. The fissure is located posteriorly in 85% of cases and anteriorly in 15% of cases. When rectal bleeding is a presenting symptom, the presence of a fissure should not preclude full colonoscopy to rule out other colorectal lesions. ### Paraphrase this passage so that it is lighter and less serious but keep the main points. It is for high school students and you do not want to scare them.

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Hugging Face

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