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Intrasphincteric botulinum toxin injection in treatment of chronic idiopathic constipation in children
Javad Ahmadi1, Saeedeh Azary1, Bahar Ashjaei1
1Department of Pediatric Surgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Botulinum toxin injections into the anal sphincter offer a safe and effective treatment for chronic constipation in children. This novel therapy significantly improved painful defecation, stool consistency, and reduced soiling and defecation intervals.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Chronic idiopathic constipation and anal fissure are common pediatric conditions.
- Refractory cases often require advanced treatment modalities.
Purpose of the Study:
- To evaluate the efficacy of intra-sphincteric botulinum toxin (Botox) injections in children with refractory constipation.
Main Methods:
- A randomized controlled trial comparing Botox injection plus medical management to medical management alone.
- Patients were assessed for signs of constipation including painful defecation, stool consistency, soiling, and defecation interval.
Main Results:
- Botox injection significantly reduced painful defecation (88% to 15%), hard stools (80% to 28%), and soiling (62% to 8%).
- Defecation intervals decreased from 9.1 days to 2.6 days in the Botox group (P=0.0001).
- Control group showed minimal improvement with medical treatment alone.
Conclusions:
- Intra-sphincteric botulinum toxin injection is an effective and safe treatment for chronic idiopathic constipation in children.
- This intervention offers a promising alternative for pediatric patients unresponsive to conventional therapies.
Objective:
Injection of botulinum toxin into the anal sphincter is a novel and safe new treatment of chronic idiopathic constipation and anal fissure in children. The purpose of this study was to determine the utility of intra sphincteric injection of botox in the treatment of children with refractory constipation.
Methods:
All children who suffered from chronic constipation for more than three months, and who had not responded to medical treatment, were referred to pediatrics surgical clinic for surgical intervention by pediatric gastroenterologist. The patients were randomly divided into cases and control group. The control group received no injection and was only treated with stool softeners. The case group received this therapy in addition to injection. After the botox injection, patients were asked about the presence of the signs of constipation including painful defecation, vomiting, stool consistence, soiling and defecation interval.
Findings:
Defecation of painful stool existed in 88% of patients before botox injection and it was reduced to 15% after botox injection. In the control group, 90% of patients had painful defecation, which reduced to 86% after medical treatment (P=0.0001). Stool was hard in 80% of patients before was reduced to 28% after botox injection. In the control group, it existed in 81% of children and reduced to 78% after medical treatment (P=0.0001). Soiling existed in 62% of patients before and was reduced to 8% after botox injection, but in the control group it reduced from 62% to 42.5% after medical treatment (P=0.0001). In the control group, 98% of the patients had defecation intervals more than 3 days and it was the same after medical treatment. In case group, this index before botox injection was 9.1 days, and after botox injection was reduced to 2.6 days (P=0.0001).
Conclusion:
Our study results showed that injection of botulinum toxin into anal sphincter is an effective and safe new treatment of chronic idiopathic constipation in children.
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