title: Side effects of botulinum toxin injection for benign anal disorders.
abstract: BACKGROUND
  Botulinum toxin A (BT-A) is a powerful biological toxin. Nevertheless, it has proved to be a remarkable therapeutic agent for the treatment of benign anal disorders. Higher doses of BT-A could change the outcome of treatment. It is not known whether doses of BT-A higher than 20 units of Botox (or corresponding doses of Dysport) are as safe for patients as lower doses of BT-A.
  
  
  METHODS
  The side effects of BT-A injections in the treatment of chronic anal fissure (105 patients) and functional outlet obstruction (34 patients) were analysed prospectively. The patients received at least 25 units of Botox or 150 units of Dysport.
  
  
  RESULTS
  The patients with chronic anal fissure complained of incontinence of flatus (one severe case and eight mild cases), incontinence of faeces (five mild cases), anal haematoma (five cases), flu-like syndrome (three cases), an acute inflammation of external anal varices (two cases), epididymitis (one case) and haemorrhoid prolapse (one case). Patients with anismus suffered from intertrigo (one case); the pain after injection lasted for 2-4 days (four cases). No life-threatening side effects after 181 injections of BT-A were observed. Most of the side effects were only transient symptoms. No significant interdependence between injection methods (injection into one or two sites) and the risk of side effects was found.
  
  
  CONCLUSIONS
  Treatment with BT-A is safe. Despite the application of higher doses of BT-A in the treatment of benign anal disorders so far, no severe side effects were observed.
authors.affiliation: Department of Internal Medicine II, St Wojciech-Adalbertus Hospital, Gdańsk, Poland. m.h.madalinski@pro.onet.pl
authors.forename: Mariusz H
authors.initials: MH
authors.lastname: Madaliński
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Sławek
authors.forename: Wojciech
authors.initials: W
authors.lastname: Duzyński
authors.forename: Blazej
authors.initials: B
authors.lastname: Zbytek
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Jagiełło
authors.forename: Zygmunt
authors.initials: Z
authors.lastname: Adrich
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kryszewski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001004:Anus Diseases / Q000188:drug therapy* / Q000473:pathology*; D001905:Botulinum Toxins / Q000008:administration & dosage* / Q000009:adverse effects*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D015552:Injections, Intralesional; D007415:Intestinal Obstruction / Q000188:drug therapy / Q000473:pathology; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D001905:Botulinum Toxins