Injections of botulinum a toxin for the treatment of anal fissures

Objective: To find out how injections of botulinum A toxin influence the healing of anal fissures.

Design: Retrospective study.

Setting: Medical University of Lodz, Poland.

Subjects: 13 patients (6 women, 7 men), mean age 49 (range 31–78), treated with injections of botulinum A toxin 50 units on either side of the anal fissure into the internal anal sphincter from May to December 1999.

Main outcome measures: Complications and relapse.

Results: Seven fissures had healed by one month and four by two months. Two remained unhealed but asymptomatic. There was no incontinence of flatus or faeces after three months of treatment. Resting anal pressure was significantly lower in 10 of 13 patients compared with before treatment (p < 0.05). One fissure relapsed after 4 months and this patient had a successful anal stretch.

Conclusion: Injection of botulinum A toxin gives good results in the treatment of anal fissures.