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Anal botox allows relaxation of the internal anal sphincter muscles as well as the overlying skin its applied to in order to accomplish the relaxation that is necessary to achieve a desired goal. One may or may not need several anal botox sessions to achieve complete success. All complications were self-limited and did not require intervention. Conclusion botox injection into the anal sphincters is accepted practice in children with hirschsprung disease, severe functional constipation, and internal anal sphincter achalasia and appears to be safe from this review. When using botox to treat chronic anal fissure, between 2025 units of botox is injected into the internal sphincter, with the injection guided by eye and digital examination. The total dose comprises of eight units into either side of the sphincter and nine units into the anterior verge. Internal anal sphincter (ias) dysfunction is a cause of refractory constipation in children. The goal of this study was to determine whether intrasphincteric injection of botulinum toxin is effective in the treatment of constipation in pediatric patients with ias dysfunction. Botox injection has gained popularity for treating this group of patients. Botox is injected close to or into the internal sphincter muscle. The injection works by causing the muscle to become paralysed and thereby reducing the amount of spasm or contraction that it undergoes in conjunction with a fissure.