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Botulinum toxin (botox) injection into the anal sphincters was first reported as a therapy to decrease obstructive symptoms in patients with hirschsprung disease after undergoing a pull through by langer in 1997. Since then, its off-label use has extended to children with other defecation disorders, including functional constipation, internal anal sphincter achalasia, colonic dysmotility, and. Botox injection treatment for anal outlet obstruction in patients with internal anal sphincter achalasia and hirschsprungs disease. Injection of botox and sphincterotomy anal fissures can be excruciatingly painful and the first way to treat them is with topical creams which should be used regularly for six weeks. Rectogesic (glyceryl trinitrate) and anoheal (diltiazem) are similar in their efficacy and should be applied at least a couple of time a day for six weeks. Your doctor will have recommended botox treatment for your anal fissure if you have already tried alternative measures without success such as creams (gtn rectogesic or diltiazem ointment), a high fibre diet, and laxatives. The success rate for an anal fissure healing after an injection of botox is 70 out of every 100 treatments. An anal fissure is a defect in the epithelium of the anal canal from the ano-cutaneous border to the linea dentata. Chronic fissures are characterised by a sentinel tag, hypertophic anal papillae, anal spasm, andor fibrosis of the inner sphincter muscle figure 1. Chronic fissures are commonly seen at 6 oclock with the patient in a recumbent position fissures at any other. if the botox injection is successful in a patient, the fissure will usually heal by the time (5-8 months) the effects of botox wear off. You may be right that the botox was injected in the wrong area in your case. How are botox injections given? We usually give 4 or 5 injections, which provides a total of 80 to 100 iu of botox. The doctor injects this small amount of liquid (1cc) i nto the anal sphincter. injection of botulinum toxin into the anal sphincter is a novel and safe new treatment of chronic idiopathic constipation and anal fissure in children. The purpose of this study was to determine the utility of intra sphincteric injection of botox in the treatment of children with refractory constipation. Botox also acts on the cause of ods and was shown to improve constipation within 1-3 weeks after the injection. Botox is delivered as a one-time injection in the puborectalis muscle and external anal sphincter (the muscle right around the anus). The injection can be performed in the clinic under local anesthesia, and the patient goes home. methods we performed a retrospective review of pediatric patients undergoing botox administration into the anal sphincter for treatment of a variety of defecation disorders between 20itionally, we performed a review of all published literature reporting complications from botox injection in this patient population.