Evaluation of botulinum toxin therapy for chronic anal fissure

Abstract

Background Chronic anal fissure causes severe anal pain that dramatically impairs patient's quality of life. Despite a poorly understood etiology, anal fissures are characterized by continuous spasms of the internal anal sphincter. The work aims to evaluate the efficacy of botulinum toxin (BTX) local injection in relieving symptoms and healing chronic anal fissure and its complications. We also aim to popularize this simple outpatient technique. Patients and methods Thirty patients diagnosed with chronic anal fissure were included in this study. Each patient received 40 units of BTX. All patients were evaluated for pain, bleeding, and healing of the fissure from 1 to 12 months later. Results The overall complication rate was 10%, with a single incidence of temporary incontinence to flatus. The improved postdefecatory pain was reported in 25 (83.3%) patients. The fissure was completely healed in 20 (66.6%) patients. Conclusion In the clinical evaluation, BTX is a valid alternative nonsurgical modality for the treatment of chronic anal fissure. We recommend BTX as the first step in the treatment of chronic anal fissures because of the resulting chance of cure with an easily performed technique.

Keywords

• anal fissure
• anal sphincter
• btx