Written and medically reviewed by: Assoc. Prof. Cengiz Dibekoğlu, MD, General SurgeryLast updated:
Botox for Anal Fissure
Botulinum toxin temporarily reduces internal sphincter spasm to improve perfusion and healing in chronic fissures.
When soft-stool care and topical relaxant creams fail, injection of botulinum toxin into the internal anal sphincter can reduce hypertonia for months, giving the fissure a chance to heal without cutting muscle. Continence risk is lower than with division techniques, though transient mild leakage or incomplete healing can occur. It is an office/day-case option in many pathways. Soft-stool care remains the foundation even when injections or sphincterotomy are discussed.
Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.
© Cengiz Dibekoğlu — illustrative; not for unauthorized use
Figure summary
This educational figure shows: Botox.
Who may be a candidate?
- Chronic fissures failing medical therapy
- Patients wishing to avoid or delay sphincterotomy
- Selected recurrent fissures after counseling
Possible advantages
- No permanent sphincter division
- Day-case / clinic feasibility
- Can be repeated or bridged to other therapies
Limits & realistic expectations
- Effect is temporary; fissure may recur as tone returns
- Transient incontinence gas/stool possible
- Not for undiagnosed rectal disease mimicking fissure
Step-by-step overview
- 1
Confirm chronic fissure
After exam; soft-stool and topical pathways should be tried first in most cases.
- 2
Discuss continence trade-offs
Botox lowers spasm temporarily; leakage risk is usually lower than LIS but not zero.
- 3
Procedure planning
Injection sites and dose are chosen at clinic; often day-case.
- 4
Aftercare
Continue soft stools; report fever, spreading pain, or new incontinence.
- 5
Plan B if healing fails
Repeat injection or LIS may be discussed at follow-up.
Key points
Where Botox fits
After failed soft-stool care and topical relaxants, Botox offers temporary sphincter relaxation without permanent division. It bridges to healing or to LIS if needed.
How it works
Botulinum toxin reduces internal sphincter tone for months, improving blood flow to the tear. Effect wears off — that is why incontinence risk is lower than cutting muscle.
Procedure and setting
Often performed as day-case or clinic injection under local or brief anesthesia. Dose and injection sites vary by practice.
- Key note inside
Continence counseling
Transient gas or stool leakage can occur. Prior obstetric injury or loose stools raise the importance of honest consent.
Aftercare
Continue soft stools, sitz baths, and prescribed creams. Report fever, spreading pain, or worsening incontinence.
- Key note inside
Important
This page is for education. It is not medical advice and does not replace a visit with your physician.
Frequently asked questions
How does Botox help a fissure?
It temporarily relaxes internal sphincter spasm to improve blood flow and healing in selected chronic fissures.
Is it permanent?
Effects wear off; that is partly why incontinence risk is lower than cutting sphincter.
Does everyone respond?
No. Some still need surgery such as LIS.
What are common side effects?
Temporary mild incontinence to gas or stool can occur and is discussed at consent.
More chapters in this hub
Anal Fissure Symptoms
Glass-shard pain, bleeding, and when to seek care
Anal Fissure Diagnosis
Exam, acute vs chronic, and important differentials
Medical / Topical Treatment
Soft stools, sitz baths, NTG and diltiazem creams
Diet for Anal Fissure
Diet — explained for shared decision-making
Lateral Internal Sphincterotomy
LIS: what the procedure aims to do and who it fits
Appointment / info
This page is for education. It is not medical advice and does not replace a visit with your physician.
Medical editor: Assoc. Prof. Cengiz Dibekoğlu, MD · Last medically reviewed: August 2026 · English patient-education chapter.