A Comparison of Botulinum Toxin and Saline for the Treatment of Chronic Anal Fissure

Abstract

Local infiltration of botulinum toxin into the internal anal sphincter is an effective treatment of chronic anal fissure.

Botulinum Toxin A Injection in ISDN Ointment-Resistant Chronic Anal Fissures

“…No manometric data were obtained in this study, but BT-A has already proven to lower anal resting pressures [11,12,13,14]. …”

“…Healing rates vary from 43 to 83% with ≤15 IU BT-A and from 60 to 96% with ≥20 IU BT-A [2, 5, 6,30,31,32]. Most studies used Botox®.…”

“…This is an exotoxin produced by the bacterium Clostridium botulinum and a potent neurotoxin, preventing the presynaptic release of acetylcholine by binding to the presynaptic nerve terminal at the neuromuscular junction inhibiting neuromuscular transmission [1, 2, 6, 29]. By causing temporary synaptic blockade, botulinum toxin has been shown to relax the internal anal sphincter when injected into it [30] or into the external anal sphincter [31]. By contrast, injection into the internal anal sphincter has no effect on the external anal sphincter.…”

“…By contrast, injection into the internal anal sphincter has no effect on the external anal sphincter. After initially injecting BT-A in the external anal sphincter [31], it was later advised to inject in the intersphincteric region or in the internal anal sphincter, to prevent paralyzing the external anal sphincter, which regulates voluntary anal continence and is not involved in the pathogenesis of anal fissures [2, 30, 32]. …”

“…Botulinum toxin A (BT-A) is a new development in the treatment of CAFs. By injecting BT-A in the internal anal sphincter it temporarily reduces internal anal sphincter resting pressure, allowing fissures to heal [11,12,13,14]. After the promising results of 32 patients in our pilot study [15], we now evaluate the effect of BT-A injections in the first 100 consecutive patients with CAFs.…”