Botulinum toxin A and chronic anal fissures – a literature review

Abstract

BACKGROUND: The Botulinum toxin A is used in the management of chronic anal fissures. This review is aimed at consolidating the available evidence in the various aspects of the use of BT-A in the treatment of anal fissures. METHODS: A Medline search of studies related to effects of Botulinum toxin on anal fissures was performed. All relevant trials, studies, experiences and cross references were included. RESULTS: Botulinum toxin A has a demonstrable temporary paralytic effect on the anal sphincters. A varied rate of success has been observed with its use in management of anal fissures. The long term results are superior to those of exogenous nitric oxide donors and inferior to Lateral internal sphincterotomy. The need for re-injection and high recurrence rate makes it less effective than surgical options but its simplicity and lack of permanent complications make it a desirable option. CONCLUSIONS: Botulinum toxin should be considered in uncomplicated idiopathic chronic anal fissures refractory to topical nitric oxide donors and in patients unfit for anaesthesia. In view of its low complication rates and temporary effect on sphincters, it should be offered as an option prior to considering surgical intervention on the anal sphincters.