Botulinum Toxin in Treatment of Anal Fissures

Botulinum Toxin in Treatment of Anal Fissures

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Botulinum Toxin in Treatment of Anal Fissures

Botulinum toxin is used for variety of medical conditions ranging from cosmetic problems to treatment of painful conditions such as anal fissure. Botulinum toxin has become very popular and commonly used agent is cosmetic medicines from reducing wrinkles to a number of conditions.

How botulinum toxins act in treatment of anal fissure?

Botulinum toxin (commonly known and available as Botox) helps in relaxation of muscles (in case of anal fissure it relaxes anal sphincter muscles) by preventing release of acetylcholine from the nerve endings. Acetylcholine is a neurotransmitter which causes muscles to contract and by preventing acetylcholine release, botulinum toxin prevent contraction of muscle or relaxes muscles. Botulinum toxin is presently used in number of medical conditions where there is spasm of muscles such as anal fissure, due to tear in the anoderm.

The toxin (botulinum toxin) can be injected into external anal sphincter, the internal anal sphincter or in the junction between external and internal sphincter (known as intersphincteric groove), or it may be injected directly into the tear in the anoderm.

What is the dose of botulinum toxin for treatment of anal fissure?

There is no fixed and standardized dose of botulinum toxin for treatment of anal fissure, although commonly 2.5 to 20 units are used. The toxin is generally injected at two sites, i.e. on either side of the anal fissure or tear. Usually one single injection (at two sites) is sufficient for treatment. If anal fissure recurs, second injection generally causes healing of anal fissure/tear.

What are the disadvantages of botulinum toxin?

Generally 100 units of botulinum toxin are available and the cost of 100 units is several hundred dollars (costly) and the unused product can not be stored and the cost of treatment becomes quite high. Side effects of botulinum toxin include weakness of anal sphincter and as a result some degree of anal incontinence, which is generally for short duration only and pose no long term problem.

How effective is botulinum toxin for treatment of anal fissure?

Different studies show different results in respect to the effectiveness of botulinum toxin in the healing of anal fissures. In one study regarding effectiveness of botulinum toxin in treatment of anal fissure shows healing of tear/fissure to be approximately 85% 6 months after treatment, but the healing rate falls to 75% after one year and just above 60% after more than 3 years.

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