BOTULINUM TOXIN FOR TREATMENT OF CHRONIC ANAL FISSURE
Volume 14 , Issue 2 , June 2024 , Pages 199-205
Authors
1 a College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
10.17656/jsmc.10466
Keywords
Abstract
Background
Chronic anal fissure is a common disease that affects both sexes especially young adults. It causes pain and
bleeding after defecation.
Objectives
The objective of the study was to determine whether injection of botulinum toxin into the internal anal
sphincter to treat chronic anal fissures is safe and effective.
patients and Methods
A prospective study was conducted from April 1, 2018, to March 31, 2023, over a five-year period in a private
surgical clinic in Sulaymaniyah, Iraq. Data were collected from 63 patients about presenting symptoms,
physical examination, procedure and follow-up. A dose of 50 U of botulinum toxin were injected into either
side of the fissure at three and nine o’clock. Re-epithelization of the anal fissure and total absence of pain
defined complete healing of the fissure. A previously healed fissure that relapsed, had recurring symptoms,
and was clinically detectable upon physical examination was referred to as a recurrence.
Results
At 2-months follow-up complete healing of the fissure was present in 46/63 patients (73.01%) after receiving
one dose of botulinum toxin injection. At 12-months follow-up, complete healing of the fissure was present in
52/63 patients (82.53%) after receiving two injections of botulinum toxin injection. The recurrence rate was
9/63 patients (12.28%), anal incontinence rate for flatus was 1/63 patients (1.58%) that was mild, temporary,
lasted for 3 weeks and disappeared spontaneously.
Conclusion
A safe, and effective method for treating chronic anal fissure is injection of botulinum toxin into the internal
anal sphincter
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