Why the most potent toxin may heal anal fissure |
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Authors: | Mariusz Madalinski MD PhD Zygmunt Chodorowski MD PhD |
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Institution: | (1) Internal Medicine Department, St. John Hospital, Starogard Gdański, Poland;(2) Internal Medicine Institute, University of Medicine, Gdańsk, Poland;(3) ul. Kosciuszki 101/7, 80-421 Gdansk, Poland |
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Abstract: | An anal fissure is a painful linear ulcer in the lower part of the anal canal. It is very often referred to as an ischemic
ulcer. Anodermal blood flow is negatively correlated with resting pressure of the anus. Increased activity of the internal
anal sphincter may decrease the anodermal blood supply by compressing arterioles. Surgical procedures and botulinum treatment
for patients with chronic anal fissure produce a temporary reduction in anal pressure, reverse sphincter spasm, and promote
fissure healing. However, recent studies have shown that fissure healing does not appear to be dependent on reduction in mean
resting anal pressure. On the basis of the published literature, this article attempts to explain this phenomenon in detail.
The mechanism of action of botulinum toxin on the internal anal sphincter is not yet fully understood. This review focuses
on problems associated with anal fissure treatment and presents them from the wider angle of science about botulinum toxin.
In our opinion, anodermal blood flow depends not only on the “mechanical” force of sphincters but also on biochemical processes
that occur in the fissure region. |
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Keywords: | anal fissure ischemic ulcer botulinum toxin internal anal sphincter |
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