Background <p>Chronic anal fissures are more frequent in patients with inflammatory bowel disease (IBD) than in the general population. These atypical fissures are related to the underlying disease and are not caused by increased sphincter pressure.</p> Objectives <p>Description of anal fissures in Crohn’s disease and ulcerative colitis and therapeutic considerations.</p> Materials and methods <p>A literature search was performed.</p> Results <p>Approximately 10% of patients with IBD are affected by anal fissures. They are often asymptomatic and might heal spontaneously. When symptoms occur, the primary therapy is conservative as in spontaneous anal fissures. The intestinal inflammation must be considered at all times. If symptoms persist or complications develop, surgery might be indicated after accurate consideration, and proctitis must be treated first. Injection of botulinum toxin&#xa0;A, anal dilatation, fissurectomy, lateral internal sphincterotomy, and proctectomy are described. Classification systems might help in decision making.</p> Conclusion <p>Nonfistulizing perianal diseases as anal fissures are not investigated sufficiently in IBD despite their frequency and clinical impact. Recommendations for therapy are generated from smaller and partly older cohorts and expert opinions. Evidence-based guidelines are not yet available.</p>