Botox injections for acute or chronic anal fissure - Forum

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Resident

Botox injections for acute or chronic anal fissure - Ärzteforum

Post#1 »

Has anyone used Botox injections for acute or chronic anal fissure. If so how much and where do you inject. Does it work. If it paralyzes the sphincter how much control is lost and how long does it last.


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surgery

Re: Botox injections for acute or chronic anal fissure - Ärzteforum

Post#2 »

I've seen it reported in the literature, though I don't remember the reference. Botulinum toxin is very expensive and hard to get; $300 per cc. But it seems like it would still be cost-effective for treating a nonhealing anal fissure.

Grandpa Phil

Re: Botox injections for acute or chronic anal fissure - Ärzteforum

Post#3 »

I have no experience with botox but have had some success with topical nitrogylerin to help hael the fissure.

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Resident

Re: Botox injections for acute or chronic anal fissure - Ärzteforum

Post#4 »

Could you please tell me the concentration of nitroglycerine paste that you used, the frequency of application, and the outcome?

Dottore

Re: Botox injections for acute or chronic anal fissure - Ärzteforum

Post#5 »

One Hundred Cases of Anal Fissure Treated with Botulin Toxin: Early & Long-Term Results. DisColonRectum

I. Scope of paper: This study reports outcome at 6 mos in 100 pts with chronic uncomplicated anal fissure in the posterior or anterior midline who were treated with botulin toxin injection of the anal sphincter, which produces paresis of the sphincter for up to 3 mos

A. Inclusion criteria: Pts with a 3-mo history of fissure with a failed trial of conservative Rx lasting at least 2 mos; all pts were offered sphincterotomy as alternative Rx

B. Rx: 2 doses each of 0.1ml diluted toxin (2.5-5.0 units of Botox) injected into the external sphincter lateral to each side of the fissure

C. Early outcome: 78% of pts were pain-free within the 1st 3 days, & 89% had greatly reduced external sphincter tone at 1 week

D. Late outcome: At 3 mos, 5% of pts had had a relapse & 82% were asymptomatic, with normal sphincter tone, no incontinence, & completely healed fissure; by 6 mos, an additional 3% had relapse & 79% remained completely healed; the 21 pts with fissures that did not heal were referred for sphincterotomy

II. Conclusions: (A) Chronic uncomplicated anal fissures can be successfully Rxed with botulin toxin injection of the anal sphincter in the great majority of patients; (B) furthermore, since the sphincter is fully recovered at 3 mos, this Rx obviates the significant incidence of some degree of incontinence seen with sphincterotomy; (C) however, surgery is still recommended in pts with complicated fissure.

Proctologist

Re: Botox injections for acute or chronic anal fissure - Ärzteforum

Post#6 »

I also have tried the NTG ointment. To my knowledge, the only concentration available is that which is used for angina, ie, is a 2% concentration. According to the PDR, this is equivalent to about 15 gms per "inch". From what I recall off the top of my head, the published studies have a product which is a much lower concentration. I have tried it in about 12 patients. I have also tried using it myself so I could tell my patients what to expect. I personally had symptoms of a small fissure, but I didn't not have the diagnosis confirmed by someone else. My own symptoms were relieved promptly, but I did expereince some mild itching and burning, which was less bothersome than the pain. I did experience a dull headache, which was slightly worse than a headache you might get if you stopped taking your usual two cups of coffee in the morning. It lasted most of the morning. I instructed my patients to get as small a dab of the ointment (2%) on the tip of their finger, and apply it once or twice a day, depending on their symptoms and depending on the severity of their headache. I think it is worth a try in patients who are experiencing a lot of pain. The headache is the limiting factor in my limited experience.

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A Doctor

Re: Botox injections for acute or chronic anal fissure - Ärzteforum

Post#7 »

My local pharmacist compounds a 0.2% Nitroglycerine ointment for my patients, which is 10% of the standard, off the shelf 2% ointment. I found that the 2% ointment was locally irritating and also caused headaches. The 0.2% ointment doesn't have these side effects and works well. It's also cheap to make - he charges patients about $8 for a 30 gram jar.

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Doctor Green

Re: Botox injections for acute or chronic anal fissure - Ärzteforum

Post#8 »

You can ask the pharmacy to dilute to 0.25%. It still works with less headache. To be used tid and must be wiped off prior to bedtime.

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Doctor Green

Re: Botox injections for acute or chronic anal fissure - Ärzteforum

Post#9 »

We use 0.25% made up specially by pharmacy. To be applied tid and more importantly wiped off completely prior to bedtime. Most common SE is headache. It can applied until the fissure heals.

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Billroth

Re: Botox injections for acute or chronic anal fissure - Ärzteforum

Post#10 »

In Leeds we are using 0.2% as per the Lancet paper by J. Lund.

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