title: Is Botox for anal pain an effective treatment option?
abstract: OBJECTIVE
  The aim of this study was to evaluate the efficacy of Botulinum toxin-A (Botox) in relieving anal pain associated with anal fissure (AF) and Levator ani syndrome (LS).
  
  
  METHODS
  All patients with medically refractory AF or LS from 2005 to 2012 and treated with Botox injections were included.
  
  
  RESULTS
  One hundred and three patients [66 patients (53 female) with AF and 37 patients (26 female) with LS] were evaluated. The minimum/maximum dose of Botox was 20/100 units for AF and 50/200 units for LS. Thirteen (19.7%) patients with AF and 14 (38%) patients with LS received > 1 Botox treatment. The time interval between injections varied from 1 to 12 months. Mean follow-up was 6.4 months for AF and 9 months for LS. Relief of anal pain was noted in 59% of AF and 43% of LS patients. Significant changes in pre- and post-op pain scores were noted in both groups. Nine out of 12 patients with failed sphincterotomy were relieved after Botox treatment. Temporary fecal incontinence was reported in 2/66 (3%) AF patients and 4/37 (10%) of LS patients. Overall, 66% patients' recommended Botox treatment and 72% were happy with the treatment as per telephone interview results.
  
  
  CONCLUSIONS
  Botox relieves pain more effectively in AF than in LS. It is an effective option in medically refractory cases of LS. Higher doses of Botox are safe to use in LS; however, this needs to be evaluated. Botox injections have an overall low complication rate.
authors: a Department of Colorectal Surgery, Cleveland Clinic , 9500 Euclid Ave. A30, Cleveland, OH 44195, USA.
authors: Sara
authors: S
authors: Bibi
authors: a Department of Colorectal Surgery, Cleveland Clinic , 9500 Euclid Ave. A30, Cleveland, OH 44195, USA.
authors: Massarat
authors: M
authors: Zutshi
authors: a Department of Colorectal Surgery, Cleveland Clinic , 9500 Euclid Ave. A30, Cleveland, OH 44195, USA.
authors: Brooke
authors: B
authors: Gurland
authors: a Department of Colorectal Surgery, Cleveland Clinic , 9500 Euclid Ave. A30, Cleveland, OH 44195, USA.
authors: Tracy
authors: T
authors: Hull
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001004:Anus Diseases / Q000188:drug therapy*; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy*; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Anal; botulinum toxin; fissure in ano; levator ani syndrome