At a glance
Kenalog is a brand name for triamcinolone, a corticosteroid. A small number of colorectal surgeons offer a procedure for chronic anal fissures that uses a Kenalog injection. Most of them are in the US.
What people report about it:
- It is a procedure, not just a jab. In most accounts it is a day-case operation under anaesthetic. The surgeon treats the fissure itself, often by cleaning and sealing it, and injects the steroid.
- It does not cut the sphincter. This is the main reason people seek it out.
- It is hard to find. Few surgeons offer it. People describe travelling long distances and paying significant costs.
- Results are mixed. Some describe lasting relief. Others describe new problems, repeat procedures, and moving on to Botox or surgery.
- The evidence is limited. There are no large trials.
This page explains what is known and what people describe. It is not a recommendation for or against.
What the procedure involves
Descriptions vary between clinicians, but accounts commonly include:
- A general or sedation anaesthetic, in an operating theatre
- Cleaning or removing the scarred base of the fissure
- Sealing the area, often described as cautery
- Injecting triamcinolone into and around the fissure
- Sometimes gentle stretching of the area by the surgeon
Some people also have other things treated at the same time. These include a skin tag, an enlarged papilla, haemorrhoids, or a small fistula found during the examination.
Most people describe going home the same day with painkillers and stool softeners. Many are told to expect one to two weeks of discomfort, and to take several days off work.
The logic described by those who offer it is to treat the fissure as a stubborn wound. Clearing the scarred tissue gives a fresh surface to heal, and the steroid is meant to calm inflammation and scarring. This differs from Botox and sphincterotomy, which aim to lower muscle pressure.
Who offers it
Very few clinicians. Most accounts involve a small number of US colorectal surgeons. A handful describe a local surgeon agreeing to try the approach after reading about it. In some cases it is combined with Botox.
It is not part of standard UK practice. People outside the US who want it describe international travel, out-of-network costs, and difficulty arranging follow-up at home.
If you are considering it, questions to ask any surgeon include:
- How many of these have you done?
- What happens if it does not work? Who looks after me if I live far away?
- What do you do if a complication happens after I have gone home?
What people report
The first days. Many describe being numb and comfortable at first. Pain often builds as the anaesthetic wears off. First bowel movements are a common source of fear. Some describe them as easier than before. Others describe them as very painful, especially if strong painkillers caused constipation.
The first two weeks. Common themes:
- Bleeding with bowel movements, often lessening over time
- A swollen or clotted haemorrhoid, which several people describe as more painful than the fissure
- Brief leakage or loss of control while still numb
- Careful juggling of stool softeners. Too little brought hard stools. Too much brought very loose stools and irritation.
Weeks to months. Outcomes split:
- Some describe the original fissure no longer hurting, and getting back to normal life within weeks.
- Some describe the fissure improving but new small cracks or soreness appearing elsewhere.
- Some describe little change, a second procedure, or moving on to Botox or sphincterotomy.
A small number of accounts describe infection or abscess afterwards. Rarely, this has been serious and needed emergency surgery. That is why the warning signs below matter.
What the evidence says
The evidence base is thin:
- Published experience is small and comes mainly from the surgeons who developed or offer the technique.
- It has not been compared head to head with Botox or sphincterotomy in large randomised trials.
- Long-term recurrence rates are not well established.
- Any success figures you are quoted should be weighed against how little has been independently published.
For comparison, sphincterotomy, Botox and fissurectomy have larger bodies of research behind them. Our decision guide covers those options.
None of this means the procedure cannot help. It means there is less to go on when deciding, and that people’s online accounts tend to over-represent both great successes and bad outcomes.
Steroid creams are a separate caution
Do not confuse a single steroid injection given during a procedure with using steroid creams at home.
People often describe being given hydrocortisone or stronger steroid creams for “piles” before a fissure was recognised. Using steroid creams for weeks or months can:
- Thin the skin around the anus
- Make it more fragile and likely to tear
- Delay the treatment that was actually needed
Short courses are sometimes prescribed for a specific reason, and that is your clinician’s call. But steroid creams are not a fissure treatment to use on your own. See our guide to steroid cream overuse.
When to seek care
After any procedure, get urgent help (go to A&E or an emergency department, call 999 in the UK or 911 in the US, or use your surgical team’s emergency line) if you have:
- Fever, chills, or feeling suddenly very unwell
- Pain that gets worse after the first few days instead of easing
- Swelling, redness, darkening skin or severe pain spreading to the buttocks, thighs, scrotum or labia
- Heavy bleeding, or bleeding that will not stop
- Being unable to pass urine
See your GP or surgeon soon if:
- Pain is not improving by the time you were told it would
- A lump appears that is very painful or keeps getting bigger
- You have new soreness or cracks in a different spot
- You are thinking about a repeat procedure and want a second opinion
- Bleeding that is dark, mixed into the stool, or happens without pain
- A change in bowel habit lasting more than a few weeks, or narrower stools
- Unexplained weight loss, or a lump