Botulinum toxin treatment for anal fissure

M M Radwan, K Ramdan, I Abu-Azab, F M Abu-Zidan, A-Z Fikri

Abstract
Objectives: To evaluate the effectiveness of Botulinum toxin injection in the treatment of anal fissure.

Methods: 38 patients (22 males, 16 females; mean age (SD) of 33.3 (8.3) years) who have presented to Surgical Outpatient Clinic at Al Ain Hospital, United Arab Emirates, with anal fissure in the period between June 2000 and September 2001 and treated with Botulinum toxin injection were retrospectively studied. They were followed up for at least 8 weeks to evaluate the effects of treatment.

Results: Treatment with Botulinum toxin was effective in 89% of patients with chronic uncomplicated anal fissure. Two patients experienced minor incontinence in the form of a fecal soiling which disappeared later.

Conclusion: Botulinum toxin injection is an effective alternative for surgery for treatment of uncomplicated idiopathic anal fissure. Surgery should be offered to patients who do not improve with Botulinum toxin injection and to those with complicated anal fissure.

Keywords: Anal fissure, chronic, botulinum toxin, sphincterotomy