Clinic services

Sphincterotomy and Botox™ injections for anal fissure

A fissure-in-ano is a painful tear in the lining of the anal canal. Bowel movements may be associated with a severe tearing pain, often followed by a debilitating ache in the pelvis that may last several hours. When conservative measures such as dietary change and special ointments fail, the Pezim Clinic offer a surgical procedure called a lateral internal sphincterotomy or Botox™ injections into the anal area to eliminate the problem.

Severe, chronic anal fissures are associated with excessive activity of the internal anal sphincter, a small involuntary muscle in the anal canal. It is well recognized that if the contraction of the internal sphincter muscle can be reduced, fissures heal rapidly.

Treatments to reduce the internal sphincter muscle activity offered by the Pezim Clinic include chemical relaxation of the sphincter by means of nitroglycerine ointments, surgical division of the sphincter under local anaesthetic (sphincterotomy), and paralysis of the sphincter by means of Botox™ injections.

Nitroglycerin paste may be quite effective in some patients although it is associated with recurrence or failure in 40% of patients and headaches in 58% of patients. Sphincterotomy is a common treatment that is successful in over 95% of cases. Botox™ injections are very new and long-term results are not well documented. However, early results are very promising. Botox paralyzes the internal sphincter muscle for a period of 3 to 4 months and thereby relaxes it long enough for the fissure to heal. Botox™ has the advantage of not permanently dividing the sphincter as is done in a sphincterotomy operation.

At the Pezim Clinic, patients are offered a treatment plan that is customized to their symptoms, lifestyle, anatomy and preferences.