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Botulin toxin in the treatment of nonrelaxing puborectalis syndrome
1Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Cairo, Egypt.
Purpose:
To evaluate the results of botulin toxin injection in the external anal sphincter for the treatment of nonrelaxing puborectalis syndrome.
Method:
15 patients (13 women, 2 men; aged 36-48 years) were treated with botulinum A toxin injection, using a dose of 25 IU diluted in 1 ml normal saline injected into the top loop of the external anal sphincter at the 3 and 9 o'clock positions. The mean follow-up period was 14.6 +/- 3.3 (SD) months.
Results:
Two patients did not respond to the treatment while improvement occurred in 13. Straining at defecation disappeared and stool frequency was normalized. Improvement was maintained for a mean of 4. 8 +/- 1.4 SD months, after which time reinjection needed to be done. No adverse side effects were encountered.
Conclusions:
Botulin toxin injection is a simple, easy and safe method for the treatment of nonrelaxing puborectalis syndrome. It is to be considered after biofeedback has failed.