Botox injections for fissure: the day

At a glance

This guide covers what happens on the day you have botox injections for an anal fissure — the practical experience from arriving at the hospital or clinic through to going home. Not how botox works or recovery timelines (those are covered in our botox for fissure guide and the botox recovery timeline experience), but the day itself: what to expect, what it feels like, and how to prepare.

People who have been through it overwhelmingly describe the same thing: the anticipation was far worse than the reality. The procedure is quick, the experience is manageable, and the day is over faster than expected.

Before the day

Your team will provide specific instructions, which typically include:

• Fasting — if you are having sedation or general anaesthesia, you will be asked not to eat or drink for a set number of hours before the procedure. Follow these instructions exactly.
• Medications — your team will advise which regular medications to take or skip.
• What to bring — loose, comfortable clothing. A sanitary pad in case of minor spotting. Something to read or listen to during the waiting periods.
• Transport — arrange for someone to collect you. Even if the procedure seems minor, you will likely have had some form of anaesthesia or sedation.
• Time off — most people do not need extended time off work for botox alone. Many return to normal activities the next day, though some prefer to take the day after off as well.

The procedure setting

Botox for fissure is typically done in one of two settings:

• A day surgery unit in a hospital — this is the most common setting when sedation or general anaesthesia is used. You go through a standard day surgery process: check-in, pre-operative checks, the procedure, recovery, and discharge.
• An outpatient clinic — some surgeons perform the injection under local anaesthesia in a clinic setting. This is a quicker in-and-out process but less common.

The setting depends on your surgeon’s practice and the anaesthesia approach they use. Your team will tell you where to go and what to expect.

Arriving and waiting

For a day surgery setting, the process is similar to any minor procedure:

• Check-in — you are registered, shown to a bed or bay, and given a gown.
• Pre-operative checks — vital signs, medical history review, cannula placement if needed.
• Meeting the anaesthetist — if you are having sedation or general anaesthesia, the anaesthetist will discuss the plan and check for allergies.
• Meeting the surgeon — a brief visit to confirm the procedure and answer last questions.
• Waiting — people describe this as the most tedious part of the day. The actual procedure takes minutes. The waiting can take hours.

The emotional experience is predominantly anxiety. People describe feeling nervous, slightly embarrassed, and eager to get it over with. These feelings are entirely normal and your team is well accustomed to them.

Anaesthesia options

Botox for fissure can be done under several types of anaesthesia:

General anaesthesia — you are fully asleep. This is common, particularly when the surgeon also wants to examine the fissure thoroughly under anaesthesia (an EUA — examination under anaesthesia). You remember nothing. You wake up in recovery.

Sedation — you are drowsy and relaxed but not fully asleep. You may be vaguely aware of what is happening but will not feel pain and may not remember much afterwards. This is sometimes called “twilight” sedation.

Local anaesthesia — the area is numbed with a local anaesthetic injection. You are fully awake. The local injection itself can be uncomfortable — people describe it as a brief sting or burning sensation. Once the area is numb, the botox injection is not felt.

The anaesthesia choice depends on your surgeon’s preference, the clinical setting, and whether additional procedures (such as an examination or fissurectomy) are being done at the same time. If you have a preference, discuss it with your team beforehand.

What happens during the injection

The botox injection itself is remarkably brief. Here is what happens:

1. Positioning — you are placed in a position that gives the surgeon access to the anal area. The most common positions are lying on your left side or in a lithotomy position (on your back with legs supported). You will be positioned after anaesthesia takes effect.

2. Examination — the surgeon examines the fissure and surrounding tissue. Under anaesthesia, the sphincter relaxes, allowing a more thorough assessment than is possible when the area is painful and in spasm. This examination confirms the fissure location and guides the injection placement.

3. The injection — using a fine needle, the surgeon injects the botox directly into the internal sphincter muscle. The injection is placed near the fissure, typically in one or two locations. The total volume injected is small. The entire injection process takes one to three minutes.

4. Completion — that is it. There is no wound to close, no dressing to apply over a surgical site. A small gauze pad may be placed for comfort.

People who have had botox under local anaesthesia describe feeling a brief pressure or sting during the injection. Those under sedation or general anaesthesia feel nothing and are unaware of the procedure happening.

The dose question

People often ask about the botox dose. The amount used varies between surgeons and is based on clinical judgement. Common doses reported in medical literature range from around 20 to 100 units, though practices vary.

This is not something you need to decide — your surgeon will determine the appropriate dose. But it is a reasonable question to ask at your pre-operative appointment if you are curious.

Waking up and recovery

If you had general anaesthesia or sedation:

• Grogginess — you will feel foggy and sleepy. This clears gradually over one to two hours.
• The area — you may feel numbness, mild soreness, or nothing at all in the immediate aftermath. There is no surgical wound, so the post-procedure sensation is typically very mild.
• Nausea — occasional with anaesthesia. Managed with medication if needed.
• Recovery monitoring — staff will check your vitals and ensure you are recovering well. This typically takes one to two hours.

If you had local anaesthesia only:

• You are alert immediately. The numbing will wear off over the next hour or two. You may feel mild soreness once it does.
• You may be able to leave sooner than with general anaesthesia, depending on your surgeon’s protocol.

Before going home

Your team will typically:

• Check your pain level — it should be minimal. Botox alone does not create a significant wound.
• Provide instructions — what to expect over the next days and weeks, when to expect the botox to start working, and what to watch for.
• Discuss bowel management — maintaining soft stools during the treatment window is important for giving the fissure its best chance to heal. Fibre, hydration, and stool softeners are typically recommended.
• Confirm follow-up — when your next appointment is and what the plan is for monitoring.
• Ensure you can urinate — occasionally checked, particularly after procedures under general or regional anaesthesia.

Going home: what people describe

The journey home after botox is generally straightforward:

• Minimal discomfort — most people describe feeling fine or only mildly sore. There is no open wound. The injection site may be tender but this is typically very mild.
• Tiredness — the emotional and physical toll of the day, combined with anaesthesia effects, means many people feel drained. Resting for the remainder of the day is sensible.
• Eating and drinking — you can usually eat and drink normally once you are home. Your body may appreciate something light after the fast.
• The waiting begins — botox does not work immediately. The effect builds over one to two weeks. People describe a period of waiting and watching after the procedure, hoping to notice a change.

What happens in the days after

The immediate post-procedure period is notably easier than after surgical procedures:

• Day 1 — most people feel close to normal. Some mild soreness at the injection site is possible. Many people return to their usual routine.
• Days 2 to 7 — people start watching for signs that the botox is working. Some notice a subtle change — slightly easier bowel movements, reduced spasm — within the first few days. Others notice nothing yet. Both are normal.
• Weeks 1 to 2 — the botox effect continues building. Most people report noticing a meaningful difference by this point. The sphincter relaxes, bowel movements become less painful, and the conditions for fissure healing improve.

The key message people share about this period: do not panic if you do not feel an immediate difference. Botox works gradually, not instantly.

What people wish they had known

Common reflections from people who have had botox for a fissure:

• It was much quicker and less dramatic than expected. The build-up in their mind was worse than the reality.
• The waiting for it to work was harder than the procedure. The one to two weeks before feeling the full effect can be anxious.
• Continuing sitz baths, fibre, and hydration during the treatment window matters. Botox creates the conditions for healing. Conservative care supports that healing.
• Not everyone responds the same way. Some people feel a dramatic difference. Others notice a more subtle change. Some do not respond. All of these are possible outcomes, and not responding does not mean nothing will work — it means this particular treatment was not the right fit.

When to contact your doctor

After botox for a fissure, contact your team if you experience:

• Heavy bleeding
• Severe pain that is getting worse rather than improving
• Fever
• Loss of bowel control — some temporary change in gas control is possible, but significant continence changes should be reported
• Symptoms that are not improving after two to three weeks
• Any concern that does not feel right

If you experience heavy bleeding, fever, or sudden severe pain, seek medical care promptly.