Endoscopic Ultrasound-Guided Botox Injection for Refractory Anal Fissure

Randhawa, Navkiran; Khalyfa, Ahamed; Aslam, Rida; Roebuck, M. Christopher; Inam, Mahnoor; Ayub, Kamran

doi:10.3390/jcm11206207

Cited by 2 publications

(2 citation statements)

References 16 publications

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“…Structural gastrointestinal diseases are common globally 169,170 , with the exact prevalence and incidence likely being underreported 171 . Structural gastrointestinal diseases include diseases of the anus (external haemorrhoids, anal fissures, anorectal fistulas), rectum (internal haemorrhoids, rectal prolapse, perirectal abscess) and colon (colonic polyps, diverticular disease) 172 (Table 1).…”

Section: Structural Gastrointestinal Diseasesmentioning

confidence: 99%

Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus

Dickstein,

Edwards,

Rowan

et al. 2024

Nat Rev Gastroenterol Hepatol

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The ability to experience pleasurable sexual activity is important for human health. Receptive anal intercourse (RAI) is a common, though frequently stigmatized, pleasurable sexual activity. Little is known about how diseases of the colon, rectum, and anus and their treatments affect RAI. Engaging in RAI with gastrointestinal disease can be difficult due to the unpredictability of symptoms and treatment-related toxic effects. Patients might experience sphincter hypertonicity, gastrointestinal symptom-specific anxiety, altered pelvic blood flow from structural disorders, decreased sensation from cancer-directed therapies or body image issues from stoma creation. These can result in problematic RAI -encompassing anodyspareunia (painful RAI), arousal dysfunction, orgasm dysfunction and decreased sexual desire. Therapeutic strategies for problematic RAI in patients living with gastrointestinal diseases and/or treatment-related dysfunction include pelvic floor muscle strengthening and stretching, psychological interventions, and restorative devices. Providing health-care professionals with a framework to discuss pleasurable RAI and diagnose problematic RAI can help improve patient outcomes. Normalizing RAI, affirming pleasure from RAI and acknowledging that the gastrointestinal system is involved in sexual pleasure, sexual function and sexual health will help transform the scientific paradigm of sexual health to one that is more just and equitable. Sections Key points• Receptive anal intercourse (RAI) is common worldwide.• Pleasurable RAI occurs through stimulation of the perianal or anal nerves and prostate or paraurethral glands, inducing vasodilation, erectile tissue engorgement, anopelvic tissue sensitization, and anal sphincter and pelvic muscular contractions.• Patients with a stoma and anorectal stump should be counselled on hygiene and dilator use to minimize infections, maintain anorectal patency, and prevent a permanent stoma, promoting RAI restoration.• Antidiarrhoeals, anti-flatulence medications, fibre supplements, lower residue diet to control regularity, avoiding spicy foods, timing meals, and defecation prior to RAI can help control symptoms and relieve distress.• Survivors of anal, rectal, and colon cancer and patients with gastrointestinal disease should be counselled on problematic RAI due to anal sphincter, neurovasculature, and prostate or paraurethral gland damage resulting in arousal dysfunction, anodyspareunia or orgasm dysfunctions.• Management strategies, including anal dilators for anodyspareunia, anal vibrators for arousal disorders, pelvic floor strengthening for anorgasmia and psychological interventions for decreased desire, should be discussed with patients.Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author selfarchiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

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Section: Structural Gastrointestinal Diseasesmentioning

confidence: 99%

Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus

Dickstein,

Edwards,

Rowan

et al. 2024

Nat Rev Gastroenterol Hepatol

View full text Add to dashboard Cite

show abstract

“…EUS-guided botulinum toxin injection into the internal anal sphincter showed promising results in these patients with chronic anal fissures, as EUS provides direct visualization, thus ensuring injection to the internal anal sphincter only. However, with conventional endoscopic botulinum toxin injections in patients with anal fissures, injections are administered blindly without direct visualization, so they can be injected into the submucosa or muscle, thus decreasing the efficacy of treatment [9].…”

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confidence: 99%