Botulinum Toxin for Fissure
Anal fissure is a painful condition where a tear in the anal canal fails to heal.
When it has been present for more than three months it is known as a chronic anal fissure, and resembles a small ulcer in the anal canal. It causes sharp pain on moving the bowels, and can be associated with intense anal spasm which results in prolonged pain, often lasting up to twelve hours after opening the bowels. This spasm is also believed to impair healing of the fissure.
Most fissures will respond to regular laxative to soften the stool combined with the application of glyceryl trinitrate or diltiazem paste. Those which fail to respond maybe considered for botulinum treatmen.
HOW DOES IT WORK?
Botulinum toxin reduces spasm in the sphincter muscle, reducing pain and promoting healing of the fissure. The effect lasts for 2-3 months and occasionally benefits from repeat treatment.
HOW EFFECTIVE IS THIS TREATMENT?
Up to 50% of patients with chronic anal fissure will heal following botulinum toxin injection coupled with the use of regular laxative.
In patients with severe chronic fissure, the injection of botulinum toxin may be combined with excision of the anal fissure (fissurectomy). This aims to create a healthy wound, which in combination with the effects of botulinum toxin and regular laxative, allows healing of the fissure in the majority of patients. This healing is a slow process and may take several months to complete, however, during this phase symptoms are usually much improved. In many patients the site of the fissure remains vulnerable to recurrence for many months or even years and it is important to avoid constipation in the future.
HOW DO I PREPARE FOR THE TREATMENT?
There is no special preparation if the botulinum toxin is performed in clinic. You can eat and drink normally before your appointment.
Botulinum toxin maybe injected under general anaesthetic. This is usually the case when combined with fissure excision. In this case, you will prepare as for any other operation. The hospital will guide you through this.
WHAT HAPPENS DURING THE PROCEDURE?
When the treatment is carried out in clinic, you will be asked to lie on your side or tummy on a couch. There is usually an injection of local anaesthetic to numb the anal region and the botulinum injection is then quick and painless.
WHAT HAPPENS AFTER THE PROCEDURE?
Your bottom may feel uncomfortable for a day or so after the local anaesthetic wears off. Most patients are able to resume normal activities within 24 hours.
There is a small risk of bleeding, bruising or infection.
Please be advised that the information on this website is not a substitute for professional medical advice, diagnosis or treatment