FRIDAY, May 24, 2002 (HealthDayNews) -- Botox has found a niche as a temporary fix for some of the body's more embarrassing indignities -- crow's feet, excessive sweating, even incontinence. So perhaps it makes sense the toxin is now being called upon for pains of a posterior nature.
In addition to popular uses for wrinkle removal and various muscle spasms, some doctors are already using Botox to help heal painful tears in the skin of the anus called anal fissures. Now, British researchers say the compound could be an effective treatment for the severe pain that can follow surgery to remove hemorrhoids.
Consisting of the same bacterium that causes a deadly form of botulism, Botox has been deemed safe for several uses by the U.S. Food and Drug Administration and works by weakening muscles and preventing spasms. It is administered in relatively painless injections that last for periods ranging from days to weeks.
The research, to be presented at the American Society of Colon and Rectal Surgeons annual meeting June 3-8 in Chicago, shows that patients treated with Botox following hemorrhoid removal surgery reported significant reductions in pain and lower usage of pain-reducing narcotics, compared with a control group that did not receive Botox treatments.
The study involved 50 patients undergoing a standard hemorrhoid removal procedure. Patients received either 0.4 milliliters of Botox or 0.4 milliliters of saline solution injected into the internal sphincter following the procedure.
To measure the treatment's impact on postoperative pain, patients were asked to score their levels of pain in ratings ranging from no pain at all to the worst pain imaginable for seven days following surgery. In addition, levels of morphine received from patient-controlled drug release systems were measured during the first 24 hours following surgery.
The researchers found that patients treated with Botox used anywhere from 6 milligrams to 27 milligrams of morphine -- a median of 16 milligrams -- following surgery, while those in the control group used more, 13 milligrams to 41 milligrams of the narcotic -- a median of 22 milligrams.
Those in the Botox group also reported significantly lower pain scores in the seven days following surgery, compared to the control group.
When pain from a hemorrhoidectomy is severe, doctors will sometimes resort to removal of the internal sphincter, which some believe causes spasms that are behind the pain. However, the researchers say the potential for consequent fecal incontinence from that procedure led them to look to Botox as an alternative.
"We wanted to assess the value of instead performing a chemical sphincterotomy with Botox to reduce pain following a standard hemorrhoidectomy," lead researcher Dr. Justin Davies, a colorectal surgeon with York District Hospital in the United Kingdom, says in a statement.
"We found that we were able to reduce pain [with Botox] without complications," he says.
Dr. Bruce A. Orkin, professor of surgery and director of the division of colon and rectal surgery at George Washington University, says the findings offer much promise because the pain notoriously associated with surgical hemorrhoid removal scares many away from the procedure.
"The main issue with having a hemorrhoidectomy is pain -- no one wants to have the procedure because they know it hurts," he says.
Orkin says it typically takes a week or two to get through the acute phase of the postoperative pain, and then another three to four weeks to fully recover. Patients are usually treated with pain medication and recommendations of tub baths and rest.
Very few patients actually go on to have the internal sphincter removed for treatment of the pain because of the permanence of the potential side effects. The temporary nature of Botox makes it an attractive alternative treatment for pain, he says.
"It's feasible that Botox might cause some of the same side effects of incontinence [that are caused by inner sphincter removal], but unlike that measure, the problem would at least be temporary, as opposed to permanent," says Orkin.
"It likely will take time for Botox to be an accepted approach for this purpose, but it's certainly a welcome finding," he adds.
The majority of patients with hemorrhoids don't require surgery at all -- most can be relieved either with home treatments such as dietary changes and taking sitz baths, or with procedures that can be performed on an outpatient basis, Orkin says.
If you suffer from hemorrhoids and are feeling a bit embarrassed -- don't be. According to the American Society of Colon and Rectal Surgeons, more than half the population will develop hemorrhoids, usually after age 30, and millions of Americans currently suffer from the problem.
What To Do
Visit the American Society of Colon and Rectal Surgeons for more information on hemorrhoids and the various treatments.
And you can read more about Botox and how it works in the context of the U.S. Food and Drug Administration's Talk Paper on its approval of the treatment for wrinkle removal.
