Anal fissure botulinum toxins

Involuntary muscle spasm blepharospasm, hemifacial spasm, spasmodic torticollis, and indeed the spasm of chronic anal fissure, are treated with botulinum toxin. This irreversibly blocks release of acetylcholine from cholinergic nerve endings and is injected locally. Its effect lasts about 3 months. Botulinum toxin is at least partially effective in up to 90% of patients with these conditions. Mild dysphagia occurs in 30% of patients receiving injections into their neck for torticoUis due to spread of the toxin in to the pharyngeal muscles. 

Anal fissures are often intensely painful due to sphincter spasm. Anaesthetic ointments and stool softening agents have been widely used, with surgery (lateral internal sphinterotomy) for severely affected cases, but this procedure can cause incontinence from loss of sphincter control. An alternative is topical application of nitrate which heals two-thirds of fissures. Preparations should be diluted to 0.2% as such use may be complicated by headache tolerance can develop. Intrasphincteric injection of botulinum toxin has also been shown to be effective. 

Brisinda G, Maria G, Bentivoglio AR, Cassetta E, Gui D, Albanese A. A comparison of injections of botulinum toxin and topical nitroglycerin ointment for the treatment of chronic anal fissure. N Engl J Med 1999 341(2) 65-9. 

Uses The uses of botulinum toxin in Parkinson s disease [54" ], anal fissure [55" ], women with chronic pain [56" ], spasticity after stroke in adults [57", 58 ], and urological conditions [59 have been reviewed. The pharmacology and formulations of botuhnum toxins and data from clinical trials, demonstrating their efficacy in dystonia, spasticity, tics, tremor, dysphonia, and autonomic disorders, have been reviewed [60 ]. 

Festen S, Gisbertz SS, van Schaagen F, Gerhards MF. Blinded randomized clinical trial of botulinum toxin versus isosorbide dinitrate ointment for treatment of anal fissure. Br J Surg 2009 96(12) 1393-9. 

Uses The uses of botulinum toxin in Parkinson s disease [48"], anal fissure [49, and women with chronic pain [50 have been reviewed. 

Comparative studies In a randomized blinded comparison of botulinum toxin with isosorbide dinitrate in the treatment of chronic anal fissure, adverse effects were similar in the two groups [51. ... 

A review of investigations of the efficacy and safety of botulinum toxin in the treatment of anal fissure demonstrated that this can be considered a minimally invasive therapeutic option for the treatment of chronic anal fissure [17 ]. 

Yiannakopoulou E. Botulinum toxin and anal fissure efficacy and safety systematic review. Int J Colorectal Dis 2012 27 1-9. 

---