For female patients with a chronic anal fissure that has not healed despite conservative management with laxatives and topical therapy, a structured evidence-based approach exists to guide the next treatment step.
This protocol is specific to female patients with a chronic anal fissure that continues to persist after treatment with laxatives and topical therapy. The primary clinical goal is complete healing of the fissure.
When laxatives and topical therapy have not achieved fissure healing, evidence supports consideration of an injection-based intervention. The full protocol — including the specific agent, administration approach, and all relevant clinical details — is available via the link below.
For female patients with chronic fissure persisting after laxatives and topical therapy, botulinum toxin may be considered.
For the treatment of anal fissure using botulinum toxin the lowest dose (20–50 U Botox or 50–100 U Dysport) may be considered.
DOI: 10.1111/codi.167
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