by NeuropathicGuy » 29 Jul 2011, 21:22
I had 30 units total, 15 in each side. Insurance covered it fully in my case, but only after other conservative treatments like the various ointments had failed. Some insurance companies consider the procedure experimental and won't cover it though. And yep, the billing code for both the procedure and the Botox can make a difference (ask your doctor about how they handle this if you're not sure).
As far as how much Botox to use and where to inject it: somewhat surprisingly, there actually isn't any "standard" consensus in the medical literature. Botox is a newer treatment for fissures so you will find numerous differences of opinion on the exact protocol, both in the literature and from doctor to doctor. IMO where the Botox is placed is probably more important than the number of units used. Botox is an extremely strong neurotoxin and it takes very little to cause paralysis. But not all doctors inject it in the same spot, which is likely what leads to some of the differences people experience in efficacy, pain during and after the shots, and so forth.
Long story short: 30 units total is within the normal range. That's what I got and it worked for me. I had it done without sedation in the doctor's office (but bear in mind that I ONLY had Botox and nothing else at the same time). My fissure was gone for months afterward. Eventually I re-tore it, however. Most people that I've seen succeed long term with Botox (and to be honest I haven't seen that many ... although many get short term relief) had several rounds in close succession (a couple months apart). If they're spaced too far apart, my opinion is that the muscle than has time to tighten up again and tear. It's all about keeping that sphincter muscle slack for as long and as continuously as possible.