Mucosal defect – a wound – located on the back of the anal canal, just above the anus.

It is characterized by extremely severe pain, like burning, during and after defecation, with scanty bleeding on toilet paper. It feels like a knot when touched, a lump, painful to the touch.

It is caused by too strong tonus of the internal sphincter of the anus, which tightens and stretches the delicate mucous membrane, which bursts and creates a defect. It usually occurs due to hard stools and difficult defecation; or, after episodes of frequent sparse stools.


Botulinum toxin can be used in the treatment of chronic anal fissures. Under general anesthesia, Botox is applied to the area of the internal anal sphincter during surgery and causes temporary muscle paresis, thus allowing the fissure to heal. This procedure leads to complete, permanent healing and healing of chronic anal fissure in 50-80% of cases.


The advantage of this topical Botox therapy is its ease of use, safety and non-invasiveness. For the patient, the recovery time is shortened and the outcome of a permanent solution to the problem is safer. Return to daily activities is possible immediately after treatment.


If the procedure is not combined with additional surgical therapy (in some cases a local excision may be done) and the patient will not feel pain after the Botox injection.

Fissure-related pain may continue for up to several weeks after Botox administration until the injection itself begins to work.


Most patients have no complications after Botox treatment. Very rarely, minor stool incontinence that is completely transient may occur. Bleeding and local infection are extremely rare. Sometimes re-application of Botox is necessary due to recurrence of anal fissure, but we must keep in mind that the internal sphincter is completely preserved and that surgery is not performed, which is a safer way of treatment for the patient.

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