Botulinum toxin for the treatment of secondary chronic anal fissure

An anal fissure is a painful tear of the sensitive anoderm, distally from the dentate line. It is a prevalent disorder and impairs quality of life dramatically. Typical or primary fissures are associated with constipation and mostly located at the posterior midline. About 1% of fissures are atypical in appearance and are generally secondary in nature. These secondary fissures should arouse attention and require further exploration for underlying conditions, such as Crohn’s disease, malignancy, trauma or venereal infections. The aim of this manuscript is to provide a comprehensive review on the clinical aspects, evaluation and treatment of secondary anal fissures.

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“…None of the fissures in these patients healed with BT. There was symptomatic improvement, but no relief of clinical symptoms (24).…”

Section: B) Ulcerative Colitis (Uc)mentioning

confidence: 92%

Secondary anal fissures: a pain in the a**

Ruymbeke¹,

Geldof²,

Looze³

et al. 2023

AGEB

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“…Botulinum toxin A is injected into the internal anal sphincter bilaterally via the inter-sphincteric groove [21,29,30]. In a non-randomised study by Minguez et al [31], a third injection at the fissure site was given in addition to the bilateral injection, which gave better symptomatic and anal tone results.…”

Section: Site Dose and Proceduresmentioning

confidence: 99%

“…A number of isolated studies have been done with different doses ranging from 2.5 to 25 units of Botox ® on each side [13,29,31,[35][36][37][38][39][40][41]. Optimum total dose seems to be 20 to 50 units of Botox ® or 0.3 units / kg [42].…”

Section: Site Dose and Proceduresmentioning

confidence: 99%

Botulinum toxin A and chronic anal fissures – a literature review

et al. 2006

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Zusammenfassung. Grundlagen: Botulinumtoxin A (BT-A) wird zur Therapie der chronischen Analfissur verwendet. In diesem Review wird versucht, die derzeitigen Ergebnisse in der Therapie der chronischen Analfissur mit BT-A zu beleuchten.Methodik: Studien zum Thema BT-A in der Behandlung der chronischen Analfissur wurden durch eine Medline-Suche identifiziert. Alle relevanten Studien wurden inkludiert. Relevante zitierte Referenzen (cross references) wurden ebenfalls berücksichtigt.Ergebnisse: BT-A hat einen vorübergehenden paralytischen Effekt auf den Schließmuskel. Die Erfolgsraten in der Behandlung der chronischen Analfissur sind unterschiedlich. Langzeitergebnisse mit der Behandlung mit BT-A sind besser als bei Verwendung topischer nitrathäl-tiger Medikamente, allerdings schlechter als nach lateraler Sphinkterotomie. Mehrmalige BT-A-Injektionen sind in vielen Fällen notwendig. Vorteil der Verwendung von BT-A sind die Einfachheit der Applikation und das Fehlen von bleibenden Nebenwirkungen.Schlussfolgerungen: BT-A sollte bei Therapieversagen nach topischen Nitraten und bei hohem Narkoserisiko zur Therapie der chronischen Analfissur bedacht werden. Aufgrund der geringen Komplikationsrate und der vorü-bergehenden Wirkung sollte die Injektion von BT-A vor einer chirurgischen Therapie angeboten werden.All relevant trials, studies, experiences and cross references were included.Results: Botulinum toxin A has a demonstrable temporary paralytic effect on the anal sphincters. A varied rate of success has been observed with its use in management of anal fissures. The long term results are superior to those of exogenous nitric oxide donors and inferior to Lateral internal sphincterotomy. The need for re-injection and high recurrence rate makes it less effective than surgical options but its simplicity and lack of permanent complications make it a desirable option.Conclusions: Botulinum toxin should be considered in uncomplicated idiopathic chronic anal fissures refractory to topical nitric oxide donors and in patients unfit for anaesthesia. In view of its low complication rates and temporary effect on sphincters, it should be offered as an option prior to considering surgical intervention on the anal sphincters.

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Nonsurgical Approaches for the Treatment of Anal Fissures

Dhawan

Chopra

2007

Am J Gastroenterol

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Chronic anal fissure (CAF) is usually associated with internal anal sphincter spasm, the relief of which is central to provide fissure healing. The treatment for CAF has undergone a transformation in recent years from surgical to medical. Both the approaches share the common goal of reducing the spasm. Though surgical treatment has a high success rate, it can permanently impair fecal continence in a large number of patients. Smooth muscle relaxation seems to be a novel way by which more than 60% of the patients can be cured with the topical use of the agents. This treatment is in addition to the normalization of stools mostly. Smooth muscle relaxation is well tolerated, can be administered on an outpatient basis, does not cause any lesion of the continence organ, and subsequently, does not lead to any permanent latent or apparent fecal incontinence. This review encompasses various agents that are used for smooth muscle relaxation. In addition, it describes various clinical studies reported in the literature with their success rates and side effects.

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Botulinum toxin for the treatment of secondary chronic anal fissure

Abstract: BT-A therapy seems effective for the treatment of chronic anal fissure after surgical or nonsurgical treatment of hemorrhoids.

Cited by 3 publications

References 8 publications

Secondary anal fissures: a pain in the a**

Secondary anal fissures: a pain in the a**

Botulinum toxin A and chronic anal fissures – a literature review

Nonsurgical Approaches for the Treatment of Anal Fissures

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