Botox Treatment for Anal Fissures

Treat anal fissures and other conditions with anal Botox at Bespoke Surgical

What is anal Botox?

Botox, also called botulism toxin, serves our community in many ways. Most people assume Botox can only be applied to the face (for wrinkles) or underarms (to curb sweating), but there are also successful applications and treatments for the anus.

Anal Botox allows relaxation of the internal anal sphincter muscles as well as the overlying skin it’s applied to in order to accomplish the relaxation that is necessary to achieve a desired goal. One may or may not need several anal Botox sessions to achieve complete success. Once the relaxation is achieved, with constant engagement and/or anal dilation, the control is usually there to stay, allowing for continued success.

Anal Botox can also be used for purely cosmetic reasons, where it can assist with anal skin de-wrinkling, depending on one’s aesthetic desires.

What conditions is anal Botox used to treat?

Anal fissure Botox is a game changer for treatment of anal fissures, which are small cuts or tears in the lining of the anus, specifically as it relates to the bottoming community, and is used quite regularly.

  • Dosage – The appropriate dosage utilized is 100 units. We inject 20 units into each quadrant of the internal sphincter, rendering it temporarily paralyzed for 3-5 months, for a total of 80 units, and then the residual 20 units directly into the fissure lines. This can be titrated to the desired effect, depending on the elasticity needed for full healing.
  • Acute Anal Fissure – If done when one initially develops the tear (all the while properly using creams and suppositories), it can assist in complete healing.
  • Chronic Anal Fissure – Most clients, unfortunately, have chronic scar tissue in the region that continuously tears during both defecation and anal intercourse.
  • Symptoms – People get pain and bleeding on and off with bouts of improvement, yet when stressing the region, recurrence occurs. With this scenario, not only do we use Botox to assist healing, but also we need to remove the chronic scar tissue (a fissurectomy) to create a healthy environment for all to heal.
  • Phantom Fissures – Many people do not specifically have fissures on initial examination, but rather develop them post-intercourse. We term these “phantom fissures”. One may go to a physician, who is not versed in appropriate bottoming management, and be given the usual medical creams that may only temporarily treat the issue. Once you begin engagement, it occurs again. This needs to be dealt with in the operating room, dilating the anal canal and creating these fissures, which then allows local treatment and the anal Botox. Healing occurs and then one can achieve their desired outcomes. Botox can also treat anal spasms (proctalgia fugax), which can be acute and quite painful.
  • Desires – Lastly, we use anal fissure Botox a lot in people who just can’t accommodate their desired girth. When attempting to achieve full acceptance, tearing occurs in both the skin and muscle lines. Using Botox in these regions allows for the relaxation that is needed to accomplish the tasks required.


Being part of the community at Bespoke Surgical, we are able to provide the most effective and efficient surgical care to keep form, function, and aesthetics as our top priority, and anal fissure Botox injections are an enormous part of our success.

Does Botox for fissures hurt?

Administering Botox for fissures feels like a little prick in the ass. If done alone—meaning no other surgical procedures are taking place concurrently—the Botox injection can be accomplished in the office. Using a simple anoscope and digital manipulation, the muscles are isolated, specifically the internal sphincter. Then, in four quadrants, 20 units of Botox are delivered via a needle injection. It’s quick and easy—just a small prick in the region. It’s very similar to getting Novocaine for your teeth. After those four injections are done, two small injections are administered on the external rim in the regions of the front and back of the anal hole. These are the regions with maximal friction that need relaxation. So, in total, there are 6 local Botox injections, which takes about 5 minutes from start to bottom.

How long does Botox take to heal a fissure?

Botox can be used to heal both acute and chronic fissures. The distinction between the former and latter depends on how much scar tissue is present, with the latter also requiring the removal of that tissue, otherwise known as a fissurectomy. Most fissures need a few weeks to truly start to granulate healthy tissue. It’s the first 3-5 days of an active fissure that sucks. From there, it’s usually 1-2 weeks during bathroom time that you are reminded of the anal cut. And finally, from there, you can start to see the light at the end of the tunnel.

Botox starts to work within that first 3-5 days and it assists healing by decreasing pressure in the anal region. This allows for maximal healing. Over the subsequent weeks, the scar tissue that develops is healthy and strong enough to withstand the pressures of defecation, specifically with the Botox on board. Now, sex is a different beast all together. Sometimes, I need to place some chemicals to encourage stronger tissue growth, which can be done in the office. After 6-8 weeks of this scar maturation, we can then start using toys in a strategic way to allow us all to reach our goals.

The friction of the toys along the scar line, combined with the relaxation from the Botox, allows for complete healing and then, of course, the ability to engage anally. Anal sex is definitely a high pressure act and can be quite traumatic if not done correctly. But with this healing regimen and the Botox, we are on the right path—the path of anal righteousness. Some people love the Botox so much that we do additions every 3-5 months to maximize one’s anal pleasures.

Anal Botox at Bespoke Surgical

In our medical practice, anal Botox is used both preventatively or as a treatment to assist in all that Bespoke Surgical is passionate about: better, safer, and enhanced bottoming. Contact us today to learn more.

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Dr. Evan Goldstein, D.O.

Dr. Evan Goldstein, D.O.

Dr. Evan Goldstein is the founder and President of Bespoke Surgical, a surgical practice for modern males and members of all other identities based in New York. He received his medical doctorate from the University of Medicine and Dentistry School of Osteopathic Medicine in 2002. Receiving the highest osteopathic education was pivotal in shaping his holistic whole-life approach towards his practice of private surgical care.

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