Anal Fissure BOTOX Treatment Better than Surgery

By | July 1, 2017
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There is a wide-range of treatments used to treat the symptoms and improve healing of anal fissures. A physician may suggest medical treatments or surgery.

Usually, medical treatments are recommended for patients with acute anal fissure. Whereas, surgery is for those with chronic anal fissures or those with unimproved conditions after 6 weeks.

A patient may be advised to undergo the following medical treatments:

  • Sitz bath

In this type of treatment, a patient sits on a tub or bath filled with warm water for 10-15 minutes two to three times a day. This helps relieve burning and inflammation.

  • Fiber therapy

Fiber adds bulk to the stool and improves bowel movement. Eating fiber-rich foods like wheat bran, whole grains, and green leafy vegetables help prevent constipation.

  • Laxatives

Laxatives are used to soften stools and prevent constipation.

  • Topical Nitroglycerin

This is applied around the anus and inside the anal canal to decrease pressure and improve blood circulation.

  • Topical Nifedipine

This is directly applied to the fissure to reduce the pressure.

  • Anesthetics and steroids

Anesthetics and steroids are used to relieve inflammation and pain.

  • Botulinum Toxin

Botulinum toxin injection is administered to a patient to cause temporary anal muscle paralysis.

If these treatments do not offer relief and healing, surgical procedures like lateral sphincterotomy may be recommended to the patient.

Botulinum Toxin Injection Versus Surgery

Botulinum toxin injection is used in the treatment of acute and chronic anal fissures.

A small dose of BOTOX is injected directly into the internal anal sphincter. This temporarily paralyzes the internal anal sphincter.

BOTOX injection decreases the incidence of muscle spasm. Thus, allowing the fissure to heal.

The effect of BOTOX injection lasts for up to three months. Surgery may be recommended if patient’s condition will recur after 3 months.

Shao et al made a conclusion that surgery or lateral internal sphincterotomy resulted to better healing of chronic anal fissures as compared to botulinum toxin injection. Their conclusion is based in their review of 4 prospective, randomized, controlled trials that involved 279 patients.

They also found out that the rate of recurrence after BOTOX injection was higher than after surgery. Minor anal incontinence was greater with surgery though.

Mentes et al conducted a study to compare lateral internal sphincterotomy and botulinum toxin injection as definitive management for chronic anal fissures.

Their study involved 111 patients. There were 61 patients under the botulinum toxin group, and there were 50 patients who belonged in the sphincterotomy group.

The results of this study are as follows:

  • Patients who received botulinum toxin had a higher healing rate, earlier recovery, and lesser complications than those who belonged in the sphincterotomy group. Although this occasionally required a repeat injection. Also, the rate of healing was slower as compared to sphincterotomy.
  • The healing rates in the first two months and first year of the patients in the sphincterotomy group were significantly higher than that of the botulinum group.
  • Both groups reached the same healing rates at 6 months.

Both Botulinum toxin injection and lateral internal sphincterotomy are effective treatments for anal fissures. However, results vary per individual.

To know more about the best treatment for you, it is best to consult a gastroenterologist or a colorectal surgeon.