Tannins, a class of polyphenolic compounds found in many plants, have been used traditionally for the management of anal fistula and fissure, mainly in the form of topical preparations such as sitz baths, ointments, or poultices. The rationale for their use is based on their astringent properties, which are believed to help contract and heal mucosal tissues, reduce inflammation, and limit minor bleeding. In traditional medicine systems, particularly Ayurveda and folk medicine, tannin-rich plant extracts (e.g., from witch hazel, oak bark, or pomegranate rind) are commonly recommended for anorectal disorders. However, the scientific evidence supporting the efficacy of tannins for anal fistula or fissure is limited. While some in vitro and animal studies demonstrate that tannins possess anti-inflammatory, antimicrobial, and wound-healing properties, robust clinical trials in humans specifically addressing anal fissure or fistula are lacking. Most available evidence is anecdotal or consists of small, uncontrolled studies. The astringent effect may offer symptomatic relief, such as reducing local irritation or bleeding, but it is not established as a cure or primary treatment. Modern clinical management of these conditions typically relies on pharmacological agents (e.g., topical nitrates, calcium channel blockers) and surgical interventions. In summary, the use of mixed tannins for anal fistula or fissure is primarily justified by traditional use, with only modest scientific rationale and limited direct clinical evidence supporting their effectiveness for this specific indication.