Repair of Anal Fissure

What's an Anal Fissure?

An anal fissure is a common and painful problem caused by a small tear or ulcer (open sore) in the lining of the anus (back passage), just at the opening to the outside. This can cause bleeding, itching and pain with bowel movements, which can sometimes be severe.

Anal fissures usually heal within a few weeks, but those that have not healed within 4-6 weeks are called chronic fissures.

There are various causes, such as constipation, passing hard stools, diarrhoea, childbirth, or it can develop alongside other conditions. Sometimes there is no obvious cause for the fissure.

Why Use Botox?

Botulinum toxin (Botox) has been used for several years for the treatment of a variety of conditions which are caused by muscle over activity, such as muscle spasms in people with spinal injuries and cerebral palsy. Botox works by preventing muscles spasming (contracting).

The effects of the Botox should last for approximately 2-3 months, which should be long enough for the fissure to heal.

The Procedure

Injecting Botox into muscle around the anus (back passage) will cause it to relax and reduce muscle tension. This should reduce any pain and will increase the blood flow to the fissure, encouraging it to heal naturally.
Your doctor will have recommended Botox treatment for your anal fissure if you have already tried alternative measures without success; such as creams (GTN rectogesic or diltiazem ointment), a high fibre diet, and laxatives.

The success rate for an anal fissure healing after an injection of Botox is 75 out of every 100 treatments. Sometimes the injection might need to be repeated, which is still successful in 50 out of every 100 treatments.

What happens during the procedure?

There is no special preparation needed before the procedure. You also do not need to carry out any bowel preparation, but please do carry out your usual hygiene routine (shower or bath) before you come in.

The procedure will be carried out in the operating theatre as a day-case by a surgeon and only takes a few minutes to perform.

You should be able to return to work after 24 hours. The surgeon may also inject some local anaesthetic (numbing solution) as well as the Botox to minimise any post-operative discomfort.

The surgeon will discuss your symptoms, explain the procedure to you, and answer any questions you may have. You will then be asked to sign a consent form to confirm you are happy for the treatment to go ahead.

After the procedure we recommend that you take some painkillers, such as paracetamol, after the procedure (as needed) to relieve any soreness following the injections. The Botox will start to work gradually (usually over the next 72 hours).

It is important to make sure that you continue to keep your stools soft following the treatment, to avoid straining. Continue to include fibre in your diet or to use any laxatives you have been prescribed or would normally take.
We will contact you by telephone in 3 months’ time to discuss your progress. An appointment date and time for this telephone call will be posted to you. It is important that you check that we have the correct telephone number to contact you.

As with any surgical procedure there are potential risks of minor bleeding, infection, or (extremely rarely) an allergic reaction to the Botox. All of these risks are rare, and will be discussed in more detail with you by the surgeon on the day, before you sign the consent form.

Because the Botox relaxes the muscle around your anus, there is small risk of temporary loss of control of flatulence (wind). More rarely, there is a risk of some temporary loss of control of bowel movements until the Botox wears off (approximately 2-3 months).

There is a small chance that the Botox injections will not relieve your symptoms. Should this be the case, we will arrange a further appointment with your consultant to discuss other treatment options.