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Botulinum toxin for the treatment of chronic constipation in children with internal anal sphincter dysfunction

Katy Irani1, Leonel Rodriguez, Daniel P Doody

  • 1Department of Pediatric Surgery, Pediatric Intestinal Rehabilitation Program, Massachusetts General Hospital, Harvard Medical School, Warren 1153, Boston, MA 02114, USA.

Pediatric Surgery International
|April 30, 2008
PubMed

Insights

Botulinum toxin injections effectively treat refractory constipation in children with internal anal sphincter dysfunction. Most patients experienced significant, lasting relief, with minimal side effects, offering a safe therapeutic option.

Area of Science:

  • Pediatric Gastroenterology
  • Colorectal Surgery

Background:

  • Internal anal sphincter (IAS) dysfunction is a recognized cause of refractory constipation in pediatric patients.
  • Abnormalities in IAS resting pressure or rectoanal inhibitory reflex are key indicators.

Purpose of the Study:

  • To evaluate the efficacy and safety of intrasphincteric botulinum toxin (Botox) injections for treating constipation in children with IAS dysfunction.

Main Methods:

  • Retrospective review of 24 pediatric patients with intractable constipation and abnormal anorectal manometry.
  • Exclusion of patients with Hirschsprung's disease.
  • Intrasphincteric Botox injection into the IAS, with a minimum follow-up of 6 months.

Main Results:

  • 22 out of 24 patients (91.7%) showed significant improvement in constipation lasting over 2 weeks.
  • 12 patients (50%) experienced benefits lasting at least 6 months.
  • Five patients (20.8%) had transient postoperative incontinence.

Conclusions:

  • Intrasphincteric injection of botulinum toxin is a safe and effective treatment for intractable constipation in children diagnosed with IAS dysfunction.
  • Botox offers a viable therapeutic option for pediatric patients unresponsive to conventional treatments.

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