English

Abstract

OBJECTIVES AND AIM Chronic anal fissure is a common condition presenting to surgical OPD. The treatment for Anal Fissure is based on reducing the spasm of the internal anal sphincter, by use of local anesthetics, by muscle relaxation with the help of chemical sphincterot omy or surgical sphincterotomy. Analysis of the available literature shows that medical manipulation of the internal sphincter should be the first-line treatment in Anal Fissure. A surgical therapy is called for if the medical therapy fails or there is a recurrence. The treatment for Anal Fissure is based on reducing the spasm of the internal anal sphincter by dilating the anal canal and breaking this vicious cycle and this can be achieved by 2 methods. a) Surgical: Lateral Internal Sphincterotomy. It is a surgical technique to cure Anal Fissure. It has been favored by most of the surgeons, because it offers long-lasting relief in sphincter spasm. Lateral Internal Sphincterotomy is considered as the gold standard treatment for chronic fissures, but it permanently weakens the internal sphincter and may lead to anal deformity and incontinence in 8–30% of patients. Therefore, recently nonsurgical treatment modalities have come to the forefront. b) Non-Surgical: Smooth muscle relaxation is an effective non-surgical treatment for Chronic Anal Fissure and has advantages over surgical treatment in avoiding long-term complications. Additionally, it does not require hospitalization. Smooth muscle relaxation is also the first option in patients with a high risk of incontinence. Smooth muscle relaxation has been tried using a variety of agents, e.g., Glyceryl Trinitrate (GTN) and Botulinum Toxin (BTX). This study is to see the role of Botulinum Toxin (A smooth muscle relaxant) in non-surgical management of Chronic Anal Fissure. Materials and Methods: