الشق الشرجي المزمن في المريضات: الخطوة التالية بعد عدم تحقيق توكسين البوتولينوم للشفاء

For female patients with chronic fissure persisting after laxatives and topical therapy, botulinum toxin may be considered.

Female patients with chronic fissure persisting after laxatives and topical therapy may be considered for lateral internal sphincterotomy with caution.

In female patients having internal sphincterotomy, minimal incision of the muscle may be considered.

Alternative sphincter preserving surgery may be considered, especially in patients with continence impairment.