If you have an anal fissure that hasn’t ...

If you have an anal fissure that hasn’t healed with self-help measures and medical treatments, we may suggest a procedure to treat it. An anal fissure is a small tear or ulcer (open sore) in your skin around the opening of your anus. There are several different types of procedures available, including injections with botulinum toxin, removal of the fissure (excision or fissurectomy) and sphincterotomy. We will discuss with you which one is right for you. About treatments for anal fissure Anal fissures are often associated with having hard, painful bowel movements. They’re thought to develop when muscles around your anus, called sphincter muscles, spasm and tense up. This reduces the blood supply to the area, which stops the tear from healing properly. Having further hard bowel movements can then make the fissure come back, or get worse. Anal fissures often go away by themselves with a few self-help measures such as increasing your fibre and fluid intake to soften your stools, and taking warm baths. Your doctor may also prescribe you an ointment or cream. See our Anal fissure topic for more information on these treatment options. If these measures don’t help your anal fissure, we may suggest that you have a procedure to treat it. There are different types of procedure for anal fissures. Botulinum toxin injections What are botulinum toxin injections (Botox) for anal fissure? An injection with botulinum toxin (Botox) is a procedure that’s carried out in an operating theatre at a hospital. Your surgeon will usually suggest you try this before other surgical procedures. You’ll usually have it under general anaesthesia, which means you’ll be asleep during the procedure. Once the anaesthetic has taken effect, your surgeon will apply the injection directly into your internal sphincter muscle. The aim is to temporarily relax this muscle so that your fissure can heal. How well does it work? Around seven in 10 people find that their fissure heals after a Botox injection. Some people need a second set of injections, three to four months after the first one, in order for the fissure to heal completely. It’s possible for a fissure to return after Botox injections, sometimes years later. What are the risks? There can be some side-effects of Botox injections. Around one in 10 people find they have some problems controlling wind at first. And less commonly, some people have problems controlling bowel movements (incontinence). These problems will only last until the effects of the Botox injection wear off – usually after around three months. Very rarely, Botox can spread to other parts of your body, causing weakness in your muscles and difficulties with breathing. Fissurectomy We may sometimes suggest you have a procedure called a fissurectomy alongside Botox injections. This involves cutting away the damaged skin from around your anal fissure, along with any ‘sentinel’ skin tags (lumps of skin associated with the fissure).