Skip to content
Beverly Hills · 435 N. Bedford Dr., Suite 308Mon–Fri 9:00 am – 5:00 pmMost PPO insurance accepted
Allen KamravaMD · MBA · FACS · FASCRS

Procedure

Botox Injection (for Sphincter Spasm / Outlet Obstruction)

Request a consultation
Back to work
Immediate
Success rate
60-90%
Recurrence
Up to 40%

What it is

What is a Botox Injection for Sphincter Spasm/Outlet Obstruction?

Botulinum Toxin A (Botox) injection is a therapeutic procedure used to treat anorectal disorders caused by excessive muscle spasm, primarily chronic anal fissure and dyssynergic defecation. Botox works by temporarily blocking the release of acetylcholine at the neuromuscular junction, which results in a temporary and reversible muscle paralysis or relaxation. For an anal fissure, Botox is injected into the internal anal sphincter to cause a 'chemical sphincterotomy', reducing spasm and improving blood flow to allow healing. For dyssynergic defecation, it is injected into the puborectalis muscle to help relax the pelvic floor and facilitate evacuation.

Am I a candidate?

Who is a Good Candidate for a Botox Injection?

  • Chronic Anal Fissure: This procedure is an ideal option for patients who have failed conservative medical management (e.g., topical nitrates or calcium channel blockers) and who wish to avoid the small but permanent risk of incontinence associated with a surgical lateral internal sphincterotomy.
  • Dyssynergic Defecation: It is considered for patients with objectively confirmed paradoxical contraction or non-relaxation of the pelvic floor during attempted defecation who have failed to improve with pelvic floor physical therapy and biofeedback.

Recovery

What is the Recovery Like?

Recovery is typically immediate with no downtime. The procedure is performed in the office or as a minor outpatient procedure. Patients can return to normal daily activities right away. There may be minimal discomfort at the injection site. Pain relief for an anal fissure may take several days to a week to become noticeable as the muscle relaxes. For dyssynergic defecation, improvement in evacuation may be noticed over a similar timeframe and is often combined with continued pelvic floor physical therapy.

Risks & considerations

What are the Risks?

Botox injection for anorectal disorders is a very safe procedure with a low risk of side effects, which are almost always temporary and mild. Risks include:

  • Temporary Incontinence: For anal fissure treatment, a small number of patients may experience temporary, minor incontinence to flatus or seepage, which resolves as the effect of the toxin wears off.
  • Pain or Bruising: Mild discomfort or bruising at the injection site can occur.
  • Urinary Hesitancy: Very rarely, the toxin can affect the muscles involved in urination, leading to temporary difficulty.
  • Recurrence/Failure: The fissure may fail to heal or may recur, and symptoms of dyssynergic defecation may not improve or may return after the toxin's effect diminishes.

Sources

CallBook