Anal fissure
Persistent or recurrent anal fissures may need specialist treatment after an assessment of previous care and bowel control. Botulinum toxin injections and lateral internal sphincterotomy are different options, with different benefits and risks. An examination and individual discussion are needed before choosing a procedure.
In this guide
Overview
Anal fissures that do not respond to conservative treatments may require more advanced interventions such as Botox injections or surgery. Here’s an overview of both options:
Botox Injections
- Procedure: Botulinum toxin (Botox) is injected into the internal anal sphincter muscle to relax it and improve blood flow to the fissure, aiding in healing.
- Indications: Suitable for fissures that haven’t responded to conservative treatments but don’t warrant surgery.
- Benefits: Reduces pain, promotes healing, and improves symptoms.
- Risks: Temporary incontinence to flatus, localized pain, rare allergic reactions.
- Duration: Effects last several months; repeat injections may be needed.
Anal Fissure Surgery (Lateral Internal Sphincterotomy
- Procedure: Involves a small incision in the internal anal sphincter muscle to reduce spasms and improve blood flow, facilitating healing.
- Indications: Recommended for chronic or severe fissures unresponsive to conservative treatments.
- Benefits: High success rate in healing fissures, reduces symptoms like pain and bleeding.
- Risks: Infection, bleeding, rare incontinence, fissure recurrence.
Choosing Between Surgery and Botox
- Factors: Severity of fissure, response to previous treatments, patient preferences.
- Effectiveness: Surgery is more effective for chronic or severe fissures; Botox is less invasive and suitable for milder cases.
- Consultation: Essential to decide the best option with a colorectal surgeon based on individual health and fissure characteristics.
Conclusion
Both anal fissure surgery and Botox injections are viable options for fissures resistant to conservative measures. The decision hinges on the fissure’s severity, previous treatment outcomes, and patient preferences. Consultation with a healthcare provider is crucial for determining the most suitable treatment approach. Each option aims to alleviate symptoms, promote healing, and improve the patient’s quality of life effectively.
A clearer picture
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Anal fissure
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1 min 27 sec · Patient informationA little more clarity
Your questions, answered
Do I need a procedure as soon as an anal fissure is diagnosed?
No. Many fissures heal without a procedure. A clinician may first recommend measures to keep stools soft and a prescribed cream. A procedure may be considered if the fissure does not heal or keeps coming back, after checking the diagnosis and reviewing previous treatment.
How do botulinum toxin injections differ from sphincterotomy?
Botulinum toxin temporarily relaxes the anal sphincter muscle. A lateral internal sphincterotomy involves cutting part of that muscle to reduce tension. The choice is not based on pain alone: the fissure, previous treatment, bowel control and your preferences all need discussion.
Why will the surgeon ask about my existing bowel control?
The anal sphincter muscles help control wind and stool. Treatments that relax or divide them can affect that control. Tell the surgeon about any existing leakage, urgency, previous anal operations or childbirth injuries so that the risks and alternatives can be assessed for you.
Can a fissure persist or return after treatment?
Yes. A fissure may not fully heal or may recur, and a further assessment or treatment may be needed. Ask how healing will be checked and what the next options would be if symptoms continue. No procedure can promise that a fissure will never return.
What should be agreed before I consent to fissure treatment?
Ask which procedure is proposed, why it suits your situation, what alternatives remain and how it could affect bowel control. Confirm anaesthetic arrangements, aftercare, follow-up and whom to contact about concerns. Follow the instructions from your treating team rather than a general recovery timetable.
Sources & further reading
This guide provides general information, not an individual diagnosis or treatment plan. Your clinical team will advise what is appropriate for you.