Tuesday, March 11, 2008

Botox for Anal Fissures? How About Home Remedies First?

If you've ever been to the doctor for anal fissures, chances are you were prescribed not the modern alternative, Botox, but a cylindrical suppository containing steroid like hydrocortisone.

The idea behind treating anal fissures with steroids is that the steroid will accelerate healing if the fissure is given some time to heal. And fairly frequently, they work.

Sometimes the steroid doesn't work, so the doctor tries a nitrate. These are drugs that act the same way as the erectile dysfunction drugs Viagra, Cialis, or Levitra, only they stimulate the nerve endings of blood vessels around the anus to help hold it in place so it can heal. Nitrates are usually dispensed as ointments you have to apply directly to the fissure, by hand.

Like Viagra, Cialis, and Levitra, these nitrates cause headaches for which you don't want to take aspirin, as aspirin aggravates bleeding. The herbal remedy for this kind of headache, however, is peppermint tea.

When steroids and nitrates for anal fissures don't work, the next level of treatment is usually a fissurectomy.

Most patients misunderstand this procedure. The surgeon does not "stitch up" the fissure. The surgeon cuts it out.

And when part of the anus is surgically removed, about 5 per cent of the time the result is chronic itching and burning, the formation of a fistula (essentially, a second anus), inability to urinate, or incontinence necessitating the use of adult diapers.

There had to be a better way. This may be Botox. Why Botox? Well if your anal sphincter is partially paralyzed, you certainly won't be straining.

Of course, that reality produces its own problems. And Botox can actually cause worse problems than the anal fissure, namely a thrombosed (blood filled) hemorrhoid.

So what to do about anal fissures?

The blood on the toilet tissue may be disconcerting (bright blood is always a healthier sign than dark blood, by the way), but over the long run you may get the most relief by treating constipation, and by being as relaxed as possible when you toilet.

You may also be interested in:

WASH for Anal Fissures.

6 comments:

  1. This information about anal fissures in this blog is ether somewhat incorrect on a few of the points that were made or the author did not include other methods. For an Anal fissure to repair itself the anus has to be allowed to relax to allow the blood to reach the wound. The anus has two types of muscles, the inner muscle l is a involuntary and the outer muscle is controllable. Typically a fissure is a tear that goes from the inside lip of the bowel to the outside of the anus and leaves a protruding skin tag. The inner muscle spasms tightly and stays clamped, cutting off the blood flow that interferes with the healing processes. The information “Sometimes the steroid doesn't work, so the doctor tries a nitrate” is for the most part outdated information. The drug now of choice that is mostly prescribed is Nifedipine 0.2% Ointment used 4 times daily. This ointment relaxes the involuntary muscles and allows the blood to flow into the fissure area. Usually over 4-8 weeks of this treatment the fissure will heal. In some chronic cases this treatment may not work for everyone. In these chronic cases many of the older surgeons will cut the inner involuntary muscle in half to prevent it from contracting and cutting the blood flow. This as you can well imagine is a painful situation as it takes 4-8 weeks to re heal. As the article states there is a small chance of a keyhole forming as it heals, bringing with it other problems as stated in the article. With the advent new use of Botox to paralyze and relax these muscles, surgery is now considered in most cases as unnecessary. The Botox is injected in 4 different quadrants around the inner lip of the anus. This treatment is often combined with oral use of Nifedipine. The Botox lasts for several ( 3-9) months and the possible key hole effect does not happen. In some chronic cases the surgery may have to still be preformed if the Botox fails to work.
    In some cases with males the penis is also affected and an erectile dysfunction can occur. The base of the penis will not full enlarge and may make the penis curl in a 90 degree angle during an attempted erection. This situation will eventually correct itself as the Botox wears off.

    ReplyDelete
  2. This information about anal fissures in this blog is ether somewhat incorrect on a few of the points that were made or the author did not include other methods. For an Anal fissure to repair itself the anus has to be allowed to relax to allow the blood to reach the wound. The anus has two types of muscles, the inner muscle l is a involuntary and the outer muscle is controllable. Typically a fissure is a tear that goes from the inside lip of the bowel to the outside of the anus and leaves a protruding skin tag. The inner muscle spasms tightly and stays clamped, cutting off the blood flow that interferes with the healing processes. The information “Sometimes the steroid doesn't work, so the doctor tries a nitrate” is for the most part outdated information. The drug now of choice that is mostly prescribed is Nifedipine 0.2% Ointment used 4 times daily. This ointment relaxes the involuntary muscles and allows the blood to flow into the fissure area. Usually over 4-8 weeks of this treatment the fissure will heal. In some chronic cases this treatment may not work for everyone. In these chronic cases many of the older surgeons will cut the inner involuntary muscle in half to prevent it from contracting and cutting the blood flow. This as you can well imagine is a painful situation as it takes 4-8 weeks to re heal. As the article states there is a small chance of a keyhole forming as it heals, bringing with it other problems as stated in the article. With the advent new use of Botox to paralyze and relax these muscles, surgery is now considered in most cases as unnecessary. The Botox is injected in 4 different quadrants around the inner lip of the anus. This treatment is often combined with oral use of Nifedipine. The Botox lasts for several ( 3-9) months and the possible key hole effect does not happen. In some chronic cases the surgery may have to still be preformed if the Botox fails to work.
    In some cases with males the penis is also affected and an erectile dysfunction can occur. The base of the penis will not full enlarge and may make the penis curl in a 90 degree angle during an attempted erection. This situation will eventually correct itself as the Botox wears off.

    ReplyDelete
  3. Thanks for your comment. The article was written in 2002--you're right. However, many men find the Botox complication a bit threatening.

    ReplyDelete
  4. What a great resource of information. I am so glad that I found this site.

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  5. I suffered from anal fissures for almost 18 months. Botox was incredibly expensive and totally useless. I got a thrombosed hemorrhoid from the injection and another hemorrhoid from the pain meds (Norco & Vicodin). The only thing that helped was visiting Dr Brett Hubbard at the Sandy Blvd Hemorrhoid Clinic East in Portland Oregon. Their non-surgical methods for healing fissures and other rectal disorders were a god-send. If anyone reading this is capable of going to Oregon for a few days, I can't recommend their clinic highly enough!

    ReplyDelete