nal fissure: a real pain in the butt (but treatable!)

Hot off the press is an article from Diseases of the Colon and Rectum. And talk about timing! Last week I gave a lecture to local GPs on modern management of the topic, and only yesterday had updated my description on ‘Anal Fissure’ (see under Common Conditions). I’ve also seen several patients this week suffering with this painful affliction, and I look forward to fixing their problem!

The crux of treatment of anal fissure,  is breaking the vicious cycle of pain, spasm and poor healing, as outlined in this diagram. 

Until recently, the gold standard treatment for fissures that did not respond to topical treatment was a surgical sphincterotomy (cutting a portion of the sphincter). This is still the gold standard in terms of healing (95%), but has a significant risk to continence – which may not become evident until later in life.

Thus, Botox has been used as an effective alternative. We know how it works for wrinkles, but not exactly for fissures. But nevertheless, it works. An article published this morning confirms my experience and what I tell patients – a 70% initial success, and then with a potential second step or administration, 95% overall. There is a risk of incontinence (up to 15-20%, and usually only to wind), but this resolves when the botox stops working (about 2 months).

See the abstract of the article below. There is no need to suffer with this problem, and your Brisbane colorectal surgeon has seen it all before, so come in by making an appointment on 3177 9751.