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Botox is a game changer for treatment of anal fissures, which are small cuts or tears in the lining of the anus, and tightness during anal sex, which can make bottoming painful and even impossible. Botox can be used to heal both acute and chronic fissures, and make anal sex more comfortable, and works within 3-5 days in most cases. Visit our NYC office or give us a call to learn more about how we can use Botox to help treat anal fissures.

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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. Botox involves injecting a purified form of botulinum toxin to temporarily relax muscles and reduce the appearance of wrinkles – although when applied to the anus, it is simply for relaxing your muscles.

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. It can be a beneficial solution for addressing conditions like anal fissures or spasms, offering relief by relaxing the muscles in the area. 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.


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.

How much botox is used to treat anal fissures?
The appropriate dosage utilized is 100 units. We inject 20 units into each quadrant of the internal sphincter, 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.

How long does the anal botox last?

The botox used to treat anal fissures leaves the sphincter area paralyzed for 3-5 months.

What types of anal fissures can the botox treat?

  • 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. The symptoms of this include getting 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.

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.


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.


Botox can be used to heal both acute and chronic fissures. The distinction between the former and the 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 are the most painful. 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 the first 3-5 days. These anal injections assist 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 altogether. 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.


  • Desires – We use anal 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.
  • Cosmetics – Anal Botox can also be used for aesthetics. The anal Botox injections can help with plumping up wrinkled skin. The cosmetic improvements that come along with anal Botox are often an added bonus when treating fissures or anal pain.


Our anal surgery practice is intimately aware of just how delicate your anus is. We have the full medical expertise to understand the appropriate placement, dosage, and success rate of anal botox for each client.

Prior to any Botox injections, we do a full evaluation with anoscopy (a camera inspection inside and out) and of your muscles. The key is understanding what type of anal and pelvic floor anatomy you have (read: what type of bottom you are).

This full evaluation determines the appropriate Botox management. Not all anuses are the same, which means the dosage and location of injection is unique to each person, and without these evaluations, you might find practitioners who are administering the same dosage to every person. It’s important to remember that muscle limits pleasurable anal sex in some people, but in others, it’s extra skin or scar, or hemorrhoids and/or fissures. Botox alone in these scenarios is not the correct management. Without this full evaluation and understanding, you will limit your hole’s potential. And by seeing 90 patients and performing 10-15 surgeries a week, all related to people who are experiencing anal limitations, we understand the best ways to improve your A-game.

Contact us today to learn more, or call us at our NYC office.

Are anal botox services covered by insurance?

Yes! Botox injections in the anal area can be medically necessary to alleviate conditions such as chronic anal fissures or sphincter spasms, which can cause significant pain and discomfort. We also accept insurance and will verify it with our team before appointments.

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Dr. Evan Goldstein, D.O.

Dr. Evan Goldstein is the Founder and CEO of Bespoke Surgical, NYC’s leading sexual health private practice. He received his osteopathic doctorate from the University of Medicine and Dentistry School in 2002 and completed his residency in General Surgery at Maimonides Medical Center. In 2020, he was named one of NYC’s top LGBTQ+ business leaders by Crain’s New York and he is involved with GLSEN, ACRIA, HRC, and Callen-Lorde’s Howard J. Brown Society. All of these experiences and affiliations have shaped his whole-life approach towards the practice of private surgical care and sexual wellness.

Read More    Dr. Evan Goldstein’s NPI record  Click to send an email to egoldstein@bespokesurgical.com

This page was medically reviewed by Dr. Evan Goldstein on December 14, 2020.



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