Internal anal sphincter botox relieves pain, improves bowel in chronic obstructive defecation
Ultrasound-guided botulinum toxin (botox) injection into the internal anal sphincter (IAS) is safe and effective for obstructive defecation as a result of Hirschsprung Disease (HD), a new study shows.
Over a median follow-up of 87 (31 to 127) weeks, improvements in enterocolitis-related symptoms were observed in 82 percent of 30 botox injection procedures administered to 12 paediatric patients (mean age 3.1±2.5 years).
Of the 30 percent of patients who reported painful bowel movements before operation, 78 percent reported improvements after operation. On the other hand, 47 percent presented with no spontaneous bowel movement before injection; 65 percent of these cases were resolved after operation.
Ultrasound was used for guidance in 43.3 percent (n=13) of the cases, of which 76 percent (n=10) showed clinical improvements after operation. By comparison, only 65 percent (n=11) of the nonultrasound-guided procedures showed improvements (p=0.69).
However, significantly more ultrasound-guided procedures did not require additional procedures as compared with the nonultrasound-guided procedures (p=0.009). There were also significantly less injections in the ultrasound-guided procedures (p=0.027).
There was no significant association between ultrasound use and improvements in spontaneous bowel movements (p=0.49), enterocolitis (p=0.87) and time to next procedure (p=0.52).
Paediatric patients recruited all received botox injection to the IAS because of IAS achalasia (n=5) or nonrelaxing IAS after HD surgery (n=7). All procedures were performed under general anaesthesia. Primary outcome was short-term improvement, while complications, number of injections and time to next procedure were secondary outcomes.
A median of two injections (one to three) yielded improvements after 70 percent (n=21) of the procedures. Secondary procedures, delivered at a median of 99 (38 to 137) days, were required in 87 percent of the patients.