Concierge colorectal · UK
Botox injections for chronic anal fissures, a sphincter-preserving alternative to surgery.
A properly delivered botulinum toxin injection into the internal anal sphincter — 2nd-line on the UK NICE and ACPGBI pathway, done under LA or sedation by a consultant colorectal surgeon, before anyone talks to you about permanent surgery.
Why patients choose us
- 01
A consultant colorectal surgeon, in theatre
Not a walk-in clinic and not a training room. A named colorectal surgeon or specialist proctologist — proper theatre, proper sterility.
- 02
Sphincter-preserving before surgery
Botox sits between topical therapy and lateral internal sphincterotomy. Fewer patients need permanent sphincter surgery when it is offered properly.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private Botox injection for anal fissure costs in the UK.
Indicative ranges across our partner clinics. Send the details and we quote firm figures across two or three options.
In short
A Botox injection under LA in our network: £900–£1,500, home the same day.
| Procedure | Indicative range | Typical duration | Recovery |
|---|---|---|---|
| Botox injection under LA | £900–£1,500 | 15 min | Same visit |
| Botox injection with sedation | £1,300–£1,800 | Half-day | Same visit |
| Repeat Botox for recurrence | £900–£1,500 | 15 min LA | Same visit |
| Lateral internal sphincterotomy (LIS) | £2,800–£4,500 | 20–30 min GA | Same visit |
| Fissurectomy (excision of chronic edges) | £2,500–£4,000 | 30 min GA | Same visit |
| Consultation only | £200–£400 | 30 min | Same visit |
Prices vary by clinic, by which surgeon does the case, and by the anaesthetic chosen. On the NHS the Botox drug is on tariff — colorectal clinics offer it as part of the standard fissure pathway. We come back with a firm quote within one working day.
The problem
The right pathway step, in the right order.
Chronic anal fissure is a pathway condition: conservative measures, then topical GTN or diltiazem, then Botox, and only then surgery. Skipping steps causes needless incontinence risk; standing still causes months of pain.
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Stuck on GTN or diltiazem?
Six to eight weeks of proper topical therapy is the test. If it has not worked, Botox is the next step — not more of the same cream.
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Been offered LIS straight away?
A permanent sphincter cut has a 5–15% incontinence risk. Botox comes first on every UK guideline for a reason.
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Fissure keeps coming back?
Recurrence is not failure — a repeat injection is usually effective and still avoids the operating theatre.
The journey
From enquiry to healing — what happens, in order.
One clinician from first message to review — including the 6–8 week healing window.
Phase 1 · Before your procedure
Concierge, off-stage for you
Phase 2 · On the day
A couple of hours at the clinic
Phase 3 · After
Concierge, back on
- 01
Before
You tell us what is going on
A short, confidential form. How long the fissure has been there, what has already been tried — GTN, diltiazem, laxatives.
- 02
Before
We come back with a recommendation
Within one working day: whether Botox is the right next step or whether more conservative measures still need a proper trial. Indicative price included.
- 03
Before
We arrange the appointment
Usually within one to two weeks. Any blood-thinning medication is reviewed with the team and you are told exactly how to prepare.
- 04
On the day
Arrival at the clinic
Arrival, consent and a chat with the surgeon and anaesthetist. Local anaesthetic — with light sedation if you would rather not be aware.
- 05
On the day
The injection itself
10 to 15 minutes. An anoscope is passed, and 20–100 units of botulinum toxin are injected in divided doses into the internal anal sphincter.
- 06
On the day
Home the same day
A short recovery, written aftercare, and home within a couple of hours. With sedation you will need someone to collect you.
- 07
After
Healing and review
Sphincter relaxation begins in 24–48 hours, peaks at two weeks and lasts around three months. Laxatives and topical therapy continue for 6–8 weeks. A review confirms healing.
Typical end-to-end: 1–2 weeks from enquiry to injection. Healing: 6–8 weeks.
When it helps
When a Botox injection is the right step.
The situations we see most, plus the one red flag that means examination and biopsy rather than an injection.
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Chronic anal fissure
A tear at the anal margin present for more than 6–8 weeks, with sharp pain on defecation and bright red bleeding.
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GTN or diltiazem failed
Topical nitrates or diltiazem tried for 6–8 weeks with no healing — Botox is the recommended 2nd-line step.
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GTN headaches intolerable
Rectogesic causes headache in 20–30% of patients. If diltiazem is also poorly tolerated, Botox is a reasonable next move.
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Recurrent fissure after healing
A fissure that heals with topical therapy but keeps coming back — Botox can break the spasm cycle.
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Post-partum fissure
Fissures after childbirth in women with fragile continence — Botox avoids the sphincter injury that LIS entails.
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Wanting to avoid LIS surgery
Younger patients, or anyone wanting to keep the option of a sphincter-preserving pathway before considering surgery.
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Elderly or previous obstetric trauma
Where LIS would carry a significant incontinence risk, Botox is the safer starting point.
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Red flag: atypical fissure
A fissure off the midline, or in a patient with weight loss or bowel changes, needs examination and biopsy — not Botox first.
Pathway options
Botox is not the only step — and rarely the first.
What each step on the UK NICE and ACPGBI fissure pathway actually involves — and which fits which patient.
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Conservative measures
Fibre (30 g/day), fluids (2 L/day), sitz baths, a stool softener (lactulose or macrogol) and simple analgesia. First-line for 6–8 weeks.
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Topical GTN 0.2–0.4%
Rectogesic ointment — a nitric oxide donor that relaxes the sphincter. Effective, but headaches limit tolerance in 20–30%.
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Topical diltiazem 2%
A compounded calcium-channel blocker cream. Similar healing rates to GTN with far fewer headaches — often preferred where available.
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Botox injection (2nd-line)
Botulinum toxin type A injected into the internal anal sphincter. Sphincter-preserving, temporary (3 months), day-case under LA or sedation.
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Repeat Botox for recurrence
10–30% of fissures recur within a year. A second injection is often effective and avoids surgery in most patients.
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Lateral internal sphincterotomy
A small permanent cut in the internal sphincter — the historic gold-standard, with 5–15% incontinence risk. Reserved for topical + Botox failure.
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Fissurectomy
Excision of the chronic scarred edges — occasionally combined with Botox rather than an LIS. Preserves the sphincter.
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Consultation only
An honest discussion of where you are on the pathway and which step actually fits — no obligation.
Our vetted UK network
A small panel of colorectal surgeons, we picked them.
Consultant colorectal surgeons and specialist proctologists across the UK. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every colorectal surgeon in our network.
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Consultant colorectal surgeons or specialist proctologists, not general clinicians
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Sedation available for anxious patients — not just topical anaesthetic and grit your teeth
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Willing to hold Botox and reinforce topical therapy if a proper trial has not been done
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Familiar with post-partum, elderly and Crohn’s cases — where the decision is subtler
Safety and recovery
What to expect afterwards — honestly.
Botox for anal fissure is a short, safe, day-case injection. The things worth planning are onset, continued topical therapy, and knowing what temporary side effects are normal.
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Local anaesthetic is the norm
Most centres inject under topical or local anaesthetic. Light IV sedation is an option if you would rather not be aware.
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Onset over days, not minutes
Sphincter relaxation begins in 24–48 hours, peaks at around two weeks and lasts about three months.
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Topical therapy continues
Laxatives, sitz baths, and GTN or diltiazem cream carry on for 6–8 weeks after the injection — Botox is not a stand-alone cure.
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Minor incontinence in 5–15%
Some patients notice temporary leakage of flatus or loose stool. This almost always resolves within three months as the Botox wears off.
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Recurrence in 10–30% at a year
A single injection is not always definitive. Repeat Botox is usually effective and still avoids surgery.
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Healing rates 60–80% at 8 weeks
For chronic fissures that have failed topical therapy, most patients heal with a single properly delivered injection.
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Not curative for everyone
A minority of patients still need fissurectomy or LIS — usually those with a very deep, long-standing fissure or a large sentinel skin tag.
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Contraindications matter
Pregnancy, active perianal sepsis, Crohn’s with anal manifestation, pre-existing incontinence and botulinum allergy all shift the plan.
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Red flags
Fever, spreading perianal pain, heavy bleeding or a new lump after injection are not normal — call the clinic or A&E the same day.
Reading your procedure note
Your procedure note in four parts. Read the last one first.
Whatever product and dose was used, the note the surgeon sends you keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Diagnosis and pathway step
Why Botox was chosen — chronic fissure of a given duration, what topical therapy was tried, and how it was tolerated.
- 02 Technique
Anaesthetic, dose and injection sites
Whether it was done under LA or sedation, the product (Botox, Dysport or Xeomin), total units, and the divided doses across the sphincter.
- 03 Findings
Fissure appearance and sentinel tag
Notes on the fissure position (posterior midline is typical), depth, any sentinel pile or hypertrophied anal papilla, and whether biopsy was needed.
- 04 Impression
Aftercare, review timing, repeat plan
Read this first: continued laxatives and topical cream, expected onset of relief, when to review, and the plan if the fissure has not healed at 8 weeks.
Recognised by major UK insurers
Cover for Botox injection for anal fissure varies by insurer — usually funded as a medically indicated 2nd-line treatment after failed topical therapy. We confirm cover before booking.
Frequently asked
Everything we get asked about Botox for chronic anal fissures.
Quick answers on pain, healing time, cost, recurrence, and how it compares with LIS surgery.
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How does a Botox injection heal an anal fissure?
The pain of an anal fissure keeps the internal sphincter in spasm, which cuts off blood supply and stops the tear healing. Botulinum toxin temporarily relaxes that spasm for around three months, restoring blood flow so the fissure can heal on its own.
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Is Botox better than lateral internal sphincterotomy (LIS)?
LIS has slightly higher healing rates but carries a 5–15% risk of permanent minor incontinence — particularly in women, the elderly and anyone with previous obstetric trauma. Botox is sphincter-preserving and reversible, so UK guidelines (NICE, ACPGBI) put it before LIS on the pathway.
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Does the Botox injection hurt?
Most patients describe pressure rather than pain. It is done under topical or local anaesthetic and takes about 10–15 minutes. Light sedation is available if you would rather not be aware — the fissure itself is far more painful than the injection.
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How long before I feel better?
Sphincter relaxation starts within 24–48 hours and reaches peak effect around two weeks in. Pain on defecation usually improves within the first week, and the fissure itself heals over 6–8 weeks with continued laxatives and topical cream.
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How much does Botox for anal fissure cost privately in the UK?
Roughly £900–£1,500 under local anaesthetic and £1,300–£1,800 with sedation. On the NHS it is available through colorectal clinics — Botox is on the drug tariff for this indication.
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What happens if the fissure comes back?
Around 10–30% of patients relapse within a year. A repeat Botox injection usually works and still avoids surgery. If two injections have failed, an LIS or fissurectomy is the next step, discussed openly with your surgeon.
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Are there side effects?
Temporary minor incontinence of flatus or loose stool in 5–15% of patients — almost always resolving within three months. Local injection pain, mild bruising and, very rarely, a short-lived headache. Systemic Botox toxicity is essentially unheard of at these doses.
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Who should not have this injection?
Pregnancy and breastfeeding are relative contraindications. Active perianal sepsis, Crohn’s disease with anal involvement (where atypical fissures need biopsy), pre-existing incontinence and a known botulinum allergy all mean a different plan is safer.
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