Botulinum neurotoxin and other treatments for fissure-in-ano and pelvic floor disorders.
BACKGROUND
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.


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.


CONCLUSIONS
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.
Maria
G
G
Department of Surgery, Catholic School of Medicine, University Hospital 'Agostino Gemelli', Rome, Italy. gbrisin@tin.it
Sganga
G
G
Civello
I M
IM
Brisinda
G
G
D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use*; D001905:Botulinum Toxins / Q000627:therapeutic use*; D002908:Chronic Disease; D003248:Constipation / Q000188:drug therapy; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy* / Q000628:therapy; D005767:Gastrointestinal Diseases / Q000188:drug therapy*; D006801:Humans; D008297:Male; D009569:Nitric Oxide / Q000627:therapeutic use*; D017773:Pelvic Floor / Q000502:physiology
D018726:Anti-Dyskinesia Agents; D009569:Nitric Oxide; D001905:Botulinum Toxins