Botulinum for Anal Fissures?

Albert B. Lowenfels, MD


April 10, 2007

Randomized Clinical Trial Comparing Botulinum Toxin Injections with 0.2 per cent Nitroglycerin Ointment for Chronic Anal Fissure

Brisinda G, Cadeddu F, Brandara F, et al.
Br J Surg. 2007;94:162-167


Can chronic anal fissures be treated effectively with drugs? The authors carried out a randomized trial comparing injection of botulinum toxin with local application of nitroglycerine in 100 patients diagnosed with chronic anal fissure. In the botulinum toxin group, 46/50 (92%) of fissures were healed at 2 months compared to 70% of patients treated with local nitroglycerine (P = .009). Long-term significant complications were rare, although nitroglycerine therapy was associated with temporary headache.


Anal fissures are not life-threatening, but the associated spasm is painful, causing great discomfort to patients. Formerly treated by surgery, now many can be managed with medical agents, without any damage to the sphincter muscles. In this randomized study, botulinum toxin was clearly superior to nitroglycerin. Botulinum weakens the internal sphincter, which recovers its functional strength in a few months.



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