Comparative study between botulinum toxin injection and partial division of puborectalis for treating anismus

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Pelvic Floor Disorders

Background:

• Anismus, a functional defecation disorder, involves paradoxical contraction of the puborectalis muscle.
• Current treatment options for anismus have varying success rates and recurrence patterns.

Purpose of the Study:

• To prospectively compare the efficacy and long-term outcomes of partial division of puborectalis (PDPR) versus botulinum toxin type A (BTX-A) injection for anismus treatment.

Main Methods:

• A prospective randomized study involving 30 male patients diagnosed with anismus.
• Patients were randomized into two groups: 15 received BTX-A injection and 15 underwent bilateral PDPR.
• Comprehensive diagnostic workup included manometry, defecography, and electromyography, with a 1-year follow-up period.

Main Results:

• PDPR achieved 100% initial success and 66.6% long-term success, with a recurrence rate of 33.4%.
• BTX-A injection showed 86.7% initial success but only 40% long-term success, with a 53.8% recurrence rate.
• Two patients (13.3%) experienced minor incontinence following PDPR.

Conclusions:

• Partial division of puborectalis (PDPR) offers superior long-term therapeutic benefits for anismus compared to botulinum toxin type A (BTX-A) injection.
• BTX-A may serve as a temporary treatment option for anismus, but PDPR provides more durable results with a lower recurrence rate.