Botulinum neurotoxin and other treatments for fissure-in-ano and pelvic floor disorders
Version of Record online: 29 NOV 2002
© 2002 British Journal of Surgery Society Ltd
British Journal of Surgery
Volume 89, Issue 8, pages 950–961, August 2002
How to Cite
Maria, G., Sganga, G., Civello, I. M. and Brisinda, G. (2002), Botulinum neurotoxin and other treatments for fissure-in-ano and pelvic floor disorders. Br J Surg, 89: 950–961. doi: 10.1046/j.1365-2168.2002.02121.x
- Issue online: 29 NOV 2002
- Version of Record online: 29 NOV 2002
- Manuscript Accepted: 4 MAR 2002
The management of disorders of the lower gastrointestinal tract, such as chronic anal fissure and pelvic floor dysfunction, has undergone re-evaluation recently. To a large extent this is due to the advent of neurochemical treatments, such as botulinum neurotoxin injections and topical nitrate ointment.
Methods and results:
This review presents, inter alia, current data on the use of botulinum neurotoxin to treat lower gastrointestinal tract diseases, such as chronic anal fissure for which it promotes healing and symptom relief in up to 70 per cent of cases. This agent has also been used selectively to weaken the external anal sphincter and puborectalis muscle in constipation and in Parkinson's disease. Symptomatic improvement can also be induced in anterior rectocele by botulinum neurotoxin injections.
Botulinum neurotoxin appears to be a safe therapy for anal fissure. It is more efficacious than nitrate application and does not require patient compliance to complete treatment. While it may also be a promising approach for the treatment of chronic constipation due to pelvic floor dysfunction, further investigation of its efficacy and safety in this role is needed before general usage can be advocated. © 2002 British Journal of Surgery Society Ltd