Botulinum toxin (Botox) injections to treat chronic anal fissures

Injections of botulinum toxin (Botox) may help heal a tear (fissure) in the anus.

The internal anal sphincter, one of two muscles that control the anus, is always under tension. If this tension (also called resting pressure) is too high, spasms and reduced blood flow can cause an anal fissure or prevent an existing one from healing. Botulinum toxin, the poison that causes botulism, temporarily paralyzes the internal anal sphincter. This reduces the spasm and allows the fissure to heal.

Botulinum injections may be more helpful than nitroglycerin ointment, but the studies do not all agree.1, 2 A review of many studies showed that injections of botulinum toxin were no better at healing anal fissure than nitroglycerin ointment.3 Fissures may return after treatment with Botox is discontinued.

Side effects of botulinum injections may include the inability to control the passage of gas (gas incontinence), pain from the injections, bleeding, infection at the injection site, and fecal incontinence. Most people do not have any side effects.4

Botulinum toxin injections can be expensive.

Citations

  1. Fruehauf H, et al. (2006). Efficacy and safety of botulinum toxin A injection compared with topical nitroglycerin ointment for the treatment of chronic anal fissure: A prospective randomized study. American Journal of Gastroenterology, 101(9): 2107–2112.
  2. Brisinda G, et al. (2007). Randomized clinical trial comparing botulinum toxin injections with 0.2 per cent nitroglycerin ointment for chronic anal fissure. British Journal of Surgery, 94(2): 162–167.
  3. Nelson R (2006, amended 2006). Non-surgical therapy for anal fissure. Cochrane Database of Systematic Reviews (4). Oxford: Update Software.
  4. Nelson R (2007). Anal fissure (chronic), search date January 2007. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

Last Updated: May 30, 2008

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