What is the role of OnabotulinumtoxinA in the treatment of anal fissures?

Updated: Nov 09, 2018
  • Author: Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

OnabotulinumtoxinA is used typically to treat muscle hypertonia and cosmetic disorders. Typically, onabotulinumtoxinA is injected into the internal sphincter, reducing hypertonia. Various dosing schemes have been used, and it is typically injected on both sides of the anal fissure. Fissure healing appears to be equally effective with lower or higher doses of botulinum toxin, although lower doses reduced the risk of incontinence and recurrence over the long term. [35]

OnabotulinumtoxinA has been shown to be as effective as topical nitrates, but with fewer adverse effects, including headache, and can be an alternative to surgery. [25, 36] Botulism toxin has not been shown to be an effective treatment when other medical therapies have failed. [37]


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