What is an anal fissure?
An anal fissure is a small tear or crack in the lining of the anal canal. It causes intense pain during and after bowel movements, and is often accompanied by a small amount of bright red bleeding.
When a fissure persists for more than six weeks without healing, it is considered chronic. In chronic cases, the pain triggers a spasm of the internal anal sphincter, which reduces blood flow to the area and prevents healing — creating a vicious cycle of pain and spasm.
Important: an anal fissure is one of the most painful conditions affecting the anal region, yet it is highly treatable. In most cases, surgery can be avoided with botulinum toxin injection, which breaks the pain-spasm cycle and allows the fissure to heal.
Common symptoms
- Severe pain during and after bowel movements, sometimes lasting for hours
- Bright red bleeding on toilet paper or in the toilet bowl
- Burning or stinging sensation around the anus
- Visible crack in the skin around the anal opening
- Muscle spasm of the anal sphincter
- Fear of going to the toilet due to anticipated pain
Botulinum toxin injection for anal fissure
Botulinum toxin type A injection into the internal anal sphincter is an effective alternative to surgery for chronic anal fissure. It acts by temporarily relaxing the sphincter, which breaks the pain-spasm cycle that prevents healing.
Mechanism of action: botulinum toxin type A blocks the release of acetylcholine at the neuromuscular junction, producing a temporary and reversible relaxation of the internal sphincter. The effect lasts 3–6 months — sufficient time for the fissure to heal completely.
How is the procedure performed?
The procedure is carried out in the clinic with topical local anaesthetic applied beforehand. It takes less than 15 minutes and the patient is discharged the same day.
Examination and diagnosis — identification of the fissure, its location and sphincter tone
Topical local anaesthesia — anaesthetic cream applied to minimise discomfort
Toxin injection — botulinum toxin type A injected directly into the internal anal sphincter
Immediate discharge — the patient can return home and resume normal activity the same day
Indications
Botulinum toxin injection is particularly indicated for:
- Chronic anal fissure — that has not healed with conservative treatment after 6 weeks
- Fissure with hypertonia of the internal sphincter confirmed on examination
- Patients who wish to avoid surgery (lateral internal sphincterotomy)
- Recurrent fissure following previous medical treatment
Diagnosis and treatment in a single visit
Dr. Jaime Jorge Cerrudo performs the examination, diagnosis and botulinum toxin injection in the same appointment, without the need to schedule a separate visit.
No surgery or general anaesthesia
Rapid recovery
Procedure under 15 minutes
Reversible and safe effect