Botox for anal fissure

A chronic anal fissure is usually due to excessive activity of the internal anal
sphincter, a small involuntary muscle in the anal canal.  This increased muscle
activity leads to very high pressures within the anal canal and this may alter blood
flow, leading to cracking of the anal canal lining (fissure).  It is well recognized that
if the degree of contraction of the internal sphincter muscle can be reduced, fissures
heal rapidly.  Accordingly, treatments should not include the typical salves and
anti-inflammatories, but instead should consist of those agents and treatments that
reduce internal sphincter muscle activity.

Botox is a substance that is toxic to nervous tissue.  If injected into the area of
the internal sphincter muscle it will paralyze the muscle for 3 to 4 months, thus
reducing the pressure within the anal canal and allowing the fissure to heal.  At
least that is the theory.  And the obvious advantage is that it seems to accomplish
what the definitive surgical operation (internal sphincterotomy) does, but without
actually cutting anything.  The story is very compelling.  Results not so much.  Some
studies suggest very high success rates, in the order of 90% cure of fissures.  But
not all surgeons are able to achieve these excellent results, even though they are
using the material the same way as the authors writing those reports.  This is always
a concern in surgery.  For a procedure to be truly valuable, other well-trained
surgeons should achieve the same good results as those actively advocating the
procedure.  In addition, the effectiveness of the procedure diminishes with time.
This is not surprising since Botox only has a temporary effect.  Currently, some
surgeons no longer offer the treatment.

This is an expensive treatment since Botox is use widely in the cosmetic industry to
treat wrinkleless and so is priced high because of the cosmetic demand and the fact
that it is difficult to produce.  A fee is charged for the Botox and for the injections
(usually two sites are injected).  The material is freeze dried and must be sent in a
refrigerated state to the surgeon, usually by taxi.  It is reconstituted before use and
any remaining material must be disposed of. The Pezim Clinic does offer this service
to selected fissure patients who understand the pros and cons of the treatment and
wish to try it.

© Pezim Clinic, Vancouver, British Columbia, Canada