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Although lateral internal anal sphincterotomy remains a standard treatment for chronic anal fissure[10], botulinum toxin injection is an effective alternative to surgery especially in those with coexisting anal incontinence or anal sphincter hypotonia
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The standard approach involves 250 to 500 micrograms per day via subcutaneous injection, with peri-lesional injection as an option for superficially accessible injuries such as Achilles tendinopathy or lateral epicondylitis
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