Treatment of anal fissure without surgery – botulinum therapy

Have you ever wondered what ways there are to treat an anal fissure? Are you being offered to use surgery? Are they guaranteeing that it will get rid of the symptoms of the disease forever?
Maybe you won’t experience pain and rectal bleeding anymore, but another complication might appear. That’s why, before deciding on surgery, it’s worth knowing that there are other conservative methods for treating an anal fissure.
An anal fissure is a disease of the rectum characterized by a tear in the rectal mucosa. The cause of the disease is trauma, which occurs as a result of hard stools, prolonged constipation or diarrhea, or after instrumental methods of examining the rectum. The disease progresses in an acute or chronic form, accompanied by severe pain and bleeding.

Types of Anal Fissures

Depending on the course of the disease:

• acute form – the duration of the disease is up to 4 weeks;
• chronic form – symptoms of the disease persist for more than 1 month

Depending on the location:

• on the anterior wall of the rectum;
• on the posterior wall of the rectum;
• combined location – on both the anterior and posterior walls.

Depending on the presence of complications:

• uncomplicated;
• complicated – with secondary infection, the development of post-hemorrhagic anemia, formation of fistulas, and inflammation of the pararectal tissue.

Pathogenesis of the disease

After damage to the rectal mucosa, a wound forms. In 90% of cases, the defect is located on the posterior wall. Pain and bleeding at the beginning of the disease occur only during defecation. But as the disease persists, symptoms remain even at rest. Patients do not people fail to pay proper attention to the signs of an anal fissure or start treatment on their own, which in most cases is ineffective. The pathological process progresses from an acute form to a chronic form. The reason acute treatment is ineffective is constant spasm of the internal anal sphincter. The spasm occurs reflexively; pain signals are sent through the nerve endings of the rectum to the central nervous system. In the structures of the brain and spinal cord, the signal is transformed and through motor neurons causes contraction of the internal sphincter. With constant contraction of the anal sphincter, blood vessels around the rectum are compressed. Tissue nutrition is impaired, regenerative processes – healing – are reduced. Increased anal pressure forms, which prevents the edges of the fissure from closing. That’s why a chronic anal fissure has another name that reflects the pathogenetic mechanisms of the disease – Ischemic ulcer.

What are the dangers of the surgical treatment method?

The choice of treatment method depends on the form of the anal fissure. It is generally accepted that for the acute form of the disease, conservative methods are used. Surgery is performed in case of ineffectiveness of medication methods, as well as in the chronic stage of the disease.
Types of conservative treatment:

• healing and regenerative medicinal products;
• pain relief medications;
• antibacterial drugs;
• hormonal anti-inflammatory drugs;
• use of baths with antiseptic solutions.

Types of surgical operations:

• excision using a laser;
• radio wave excision;
• use of a traditional scalpel.

Despite the large number of treatment methods, unfortunately, not all patients manage to get rid of an anal fissure. After all, in order to start the healing process of the wound, it is necessary to remove the spasm of the internal sphincter. This cannot be achieved with therapy.
Surgery – lateral internal sphincterotomy – eliminates sphincter spasm but leads to a serious complication such as urinary incontinence, which persists for a long time. Essentially, with the surgical method, the chronic form of the disease turns into an acute form.

Advantages of botulinum therapy in the treatment of anal fissures

To achieve anal dilation (stretching), it is not necessary to perform a sphincterotomy. After all, for more than 20 years, proctology has been using the so-called “chemical sphincterotomy.” This effect is achieved by injecting botulinum toxin into the internal sphincter, which blocks pain syndrome for 3-4 months. This time is enough to relieve the spasm and allow the anal fissure to fully epithelialize.
That’s why most colorectal specialists choose botulinum therapy for treating anal fissures, as this method has several advantages:

• no urinary or gas incontinence;
• no risk of infectious complications;
• no hospitalization required for the procedure;
• no anesthesia risk, as none is needed to administer the botulinum toxin;
• only one injection is needed to achieve the therapeutic effect;
• does not cause allergic reactions;
• relieves severe pain.

Indications for botulinum therapy

There are several indications for the use of botulinum therapy:

1. Acute anal fissure.
2. Chronic anal fissure.
3. Ineffectiveness of ongoing conservative therapy.
4. Hyperhidrosis (excessive sweating) of the perianal area.
5. Anal itching.

The method does not require sedation or local anesthesia. A single injection of botulinum toxin can achieve healing of the rectal mucosa defect within 6-8 weeks. Contraindications for the procedure include concomitant anorectal diseases: fistulas, internal or external haemorrhoids, paraproctitis, malignant and benign tumors, pregnancy, and breastfeeding.

Botulinum therapy technique

The introduction of botulinum toxin into the internal anal sphincter prevents the formation of a nerve impulse. As a result, contraction does not occur, which positively affects the regeneration processes. The dosage of the drug is from 10 to 20 units, which is diluted in 1 ml of isotonic solution. Using an insulin syringe, the coloproctologist administers the drug.
After that, the doctor prescribes anti-inflammatory, healing, and regenerative medications, antibiotics, and the use of baths with antiseptic agents. This additional treatment is necessary to accelerate the healing processes.

Botulinum therapy at our center

We strive to use only minimally invasive treatment methods for proctological diseases. As a result, there are no risks of intraoperative and postoperative complications, and the patient’s quality of life improves. After just one injection, you will feel how wonderful it is to live without pain.
If you still have doubts about chemical sphincterotomy, our doctors will dispel all uncertainties. Make an appointment for a consultation with the coloproctology doctors at our medical center, and they will answer all your questions. Our call center consultants will find a convenient time for you.