46505 Chemodenervation of internal anal sphincter

Name of the Procedure:

Chemodenervation of Internal Anal Sphincter, also known as Internal Anal Sphincter Botox Injection.

Summary

Chemodenervation of the internal anal sphincter involves injecting a chemical agent, commonly botulinum toxin (Botox), into the muscle to temporarily relax it. This helps alleviate conditions related to excessive muscle contraction.

Purpose

Chemodenervation is primarily used to treat chronic anal fissures and other conditions causing persistent pain due to tight anal sphincter muscles. The goal is to reduce muscle spasms, enhance blood flow to the area, and promote healing.

Indications

• Chronic anal fissures unresponsive to conservative treatments.
• Hypertonicity of the internal anal sphincter causing severe pain.
• Patients for whom surgical options are unsuitable due to high risk or preference.

Preparation

• Fasting for a few hours prior to the procedure, if sedation is used.
• Adjustments in medications, especially blood thinners.
• Routine diagnostic tests, including rectal examination and possibly an anorectal manometry, to evaluate sphincter pressure.

Procedure Description

1. The patient is positioned comfortably, typically in a lateral or prone position.
2. Local anesthesia or light sedation is administered, if necessary.
3. A fine needle is used to inject botulinum toxin directly into the internal anal sphincter muscle.
4. The process involves multiple small injections to ensure even distribution of the toxin.
5. The entire procedure is done under sterile conditions to prevent infection.

Duration

The procedure typically takes about 15-30 minutes.

Setting

This procedure is generally performed in an outpatient clinic or hospital setting.

Personnel

• Gastroenterologist, colorectal surgeon, or trained practitioner.
• Nursing staff to assist and monitor the patient.
• An anesthesiologist, if sedation is used.

Risks and Complications

• Mild pain or discomfort at the injection site.
• Temporary incontinence of gas or stool.
• Rare risk of infection or bleeding.
• Allergic reactions to the botulinum toxin.

Benefits

• Reduction in anal sphincter spasm and pain.
• Enhanced healing of chronic anal fissures.
• Improvement typically noticed within a few days to weeks after the injection.

Recovery

• Most patients can return home shortly after the procedure.
• Avoid strenuous activities for a few days.
• Follow-up appointments to monitor progress and assess the need for further treatment.

Alternatives

• Topical medications like nitroglycerin ointment or calcium channel blockers.
• Surgical options such as lateral internal sphincterotomy.
• Each alternative carries its own set of benefits and risks, e.g., surgery has a higher risk but potentially provides permanent relief.

Patient Experience

• During the procedure: Minor discomfort or a pinching sensation at the injection site.
• Post-procedure: Mild soreness or bruising; minimal pain which can be managed with over-the-counter analgesics.
• Improved symptoms and reduced pain as the muscle relaxes over the next few days to weeks.

By understanding these detailed aspects of the chemodenervation procedure, patients and healthcare providers can make informed decisions about managing chronic anal fissures and related conditions effectively.