Botulinum Toxin A Injections for Anal Pain and Anal Fissure

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What is Botulinum toxin A?

Botulinum toxin A is a toxin protein produced by bacteria called clostridium botulinum. When injected into a muscle, it temporarily blocks neural signals for muscle contractions, causing the muscle fibers at the injection area to relax. Botulinum toxin A has been successfully used for treating a variety of medical conditions involving unwanted muscle spasms, such as strabismus and cervical dystonia. It is also commonly used in cosmetic care for removing unwanted wrinkles.

Can Botulinum toxin A be used for treating anorectal diseases?

Yes! Botulinum toxin A has been used to treat anal fissures for years. Injecting Botulinum toxin A into the anal muscles can temporarily relax the internal anal sphincter, reducing spasms and pain levels to allow the fissure to properly heal.

Most patients experience at least some amount of pain relief after being treated with Botox. The success rate for an anal fissure healing following an injection is 70 percent. Some injections might need to be repeated, especially in patients with functional anorectal pain.

What happens during the Botox procedure?

There is no special preparation needed before the injection procedure. However, patients are encouraged to have a bowel movement and to carry out their normal hygiene routine before coming into the procedure room. The entire procedure only takes a few minutes, and no anesthetic is needed.

You will be asked to lie on your left side on the exam table. The area around your anus will be cleaned with an alcohol spray. Dr. Shu will then give 6-8 injections of Botulinum toxin A into your sphincter muscle with a hair-thin needle. While the injection sensation may be slightly uncomfortable, the process is extremely quick.

What happens after the procedure?

Patients are free to drive home or return to work afterward. Botulinum toxin A will start to take effect in a few days, with effects peaking within 1-2 weeks and typically lasting 3-6 months. During this time, the anal fissures slowly start to heal.

Although most patients do not experience any side effects, potential side effects include the inability to control the passage of gas (gas incontinence), pain from the injections, bleeding, infection of the injection site, and fecal incontinence (extremely rare). Symptoms of incontinence typically disappear after several months.

Be sure to keep stool soft during this period by avoiding straining during bowel movements, regularly taking sitz baths, increasing fiber intake, and drinking enough water.

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