Therapy of Chronic Anal Fissure: Efficacy and Safety of Botulinum Toxin A Injection Compared to Topical Nitroglycerin Ointment

Aims: Chronic anal fissures (CAF) belong to the most common and painful diseases in proctology. Due to the risk of incontinence associated with surgery and side effects of nitroglycerin ointment, medical alternatives for relaxation of the anal smooth muscle have been sought. AIM: To evaluate the efficacy and safety of botulinum toxin injections compared to topical nitroglycerin ointment for the treatment of CAF. Methods: 50 outpatients with CAF, defined as evidence of a linear ulcer, a sentinel pile at the anal verge and exposure of horizontal fibres of the internal anal sphincter; and symptoms lasting for more…