Smooth muscles of the alimentary tract control gastrointestinal motility. This paper reviews possible ways in which Botulinum toxin A might be used to treat motility disorders. Preliminary results from a controlled study in rats suggest that BOTOX(R) injected into the distal stomach produces a reduction in body weight through delayed emptying of the stomach. This finding may be relevant to the short term management of obesity. Injection of BOTOX(R) into the internal smooth sphincter has produced healing scars within 2 months for 14/17 patients with chronic anal fissures. In this way the vicious circle that maintains chronic fissure might be broken, allowing for spontaneous recovery.