Injection of Botox (Anal Fissure)

Anal fissures can be excruciatingly painful, and visits to the toilet can become stressful and feared. People can avoid treatment for anal fissure due to embarassment, or uncertainty regarding possible treatment options. 

If an anal fissure fails to heal with conservative measures, the injection of botox into the internal anal sphincter, and no it’s not to achieve a wrinkle-free anus! 

An anal fissure, once formed, triggers spasm of the internal anal sphincter. Botox aims to relieve this spasm sufficiently to improve pain and suffering, and allow the fissure to heal. The injection of botox is not painful, but is often performed under anaesthetic to allow a thorough examination, and the removal of any associated tags if required. 

To help break the cycle of pain and spasm, Dr Morris routinely uses a local anaesthetic nerve block to allow up to 24 hours of relief. 

There is minimal recovery time, and given that most people have been suffering with a painful bottom already, there is usually minimal time off work. 

Treatment Principles

If you have a painful fissure, Dr Morris will not usually perform a rectal examination – he knows its already painful! Given a thorough examination may not be possible, an ‘examination under anaesthetic’ may be required to confirm the diagnosis, and allow the injection of botox and removal of tags. At this time, any haemorrhoids may also be treated if required, and there are painless options here too. 

If the fissure is scarred, it may be debrided or ‘freshened up’ to allow healing. A chronic fissure can result in a tag called a sentinel tag – this is often confused with a haemorrhoid. The pros and cons of removing this tag will be discussed in the consultation with you. 

If you are having botox, 30-50 units of botox are injected into the internal anal sphincter on each side (yes, it needs a lot more than a typical forehead!).  The effects of the botox become evident by 5-7 days, and last 2-3 months. The healing rates are in the order of 60-70%, and the procedure may need to be repeated. 

This procedure is usually done as a day case, with no restrictions on returning to work or activities as you tolerate. 

Remember that anal fissures are very common – and you don’t need to suffer unnecessarily!