Acta Scientific Clinical Case Reports

Review ArticleVolume 3 Issue 5

Management of Chronic Anal Fissure by Botulinum Toxin Injection: An Article Review

YN Irkal and Amruth H Basava*

Shreeya Multispeciality Hospital, Dharwad, Karnataka, India

*Corresponding Author: Amruth H Basava, Shreeya Multispeciality Hospital, Dharwad, Karnataka, India.

Received: April 07, 2022; Published: April 21, 2022


Chronic anal fissure (CAF) is a painful anal condition with an underlying pathophysiology of increased resting internal sphincter tone causing local ischaemia from prolonged compression of anodermal arteries. Botulinum Toxin type-A (BTX-A) is a minimally invasive management of CAF which causes reversible ‘chemical sphincterotomy’ of internal anal sphincter and reduces the anal tone. This article review analyses 6 studies which have evaluated BTX-A injection in CAF management through various aspects including its efficacy (short-term and long-term), pain relief, safety, role of patient factors, improvement in quality of life, and dose-dependent efficiency. A former meta-analytic study (6) concludes that the efficiency and postoperative incontinence rate is not dose-dependent. Moreover, the healing rates remain similar regardless of the site and number of injections per session. The results of studies are comparable with a success rate of 64.8% to 86.85% and the main side-effect of transient faecal incontinence observed in 8.6% to 13.2%. Although BTX-A injection is a safe and effective minimally invasive treatment in CAF with failed conservative management, there is a significant long-term treatment failure.

Keywords: Chronic Anal Fissure; BTX-A; Pathophysiology


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  3. Barbeiro S., et al. “Long-term outcomes of Botulinum toxin in the treatment of chronic anal fissure: 5 years of follow-up”. United European Gastroenterology Journal2 (2016): 293-297.
  4. Hemmati H., et al. “Therapeutic properties of botulinum toxin on chronic anal fissure treatment and the patient factors role”. Journal of Family Medicine and Primary Care3 (2020): 1562.
  5. Bagul A and Carter P. “Quality of Life in Patients Receiving Botulinum A Toxin Treatment for Symptomatic Anal Fissure”. World Journal of Surgery and Surgical Research 2 (2019): 1130th ser.
  6. Bobkiewicz A., et al. “Botulinum Toxin Injection for Treatment of Chronic Anal Fissure: Is There Any Dose-Dependent Efficiency? A Meta Analysis”. World Journal of Surgery 40 (2016): 3064-3072.

Citation: YN Irkal and Amruth H Basava. “Management of Chronic Anal Fissure by Botulinum Toxin Injection: An Article Review". Acta Scientific Clinical Case Reports 3.5 (2022): 76-79.

Copyright: © 2022 YN Irkal and Amruth H Basava. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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