Retrospective Study
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World J Gastroenterol. Sep 21, 2014; 20(35): 12602-12607
Published online Sep 21, 2014. doi: 10.3748/wjg.v20.i35.12602
Botulinum toxin type-A injection to treat patients with intractable anismus unresponsive to simple biofeedback training
Yong Zhang, Zhen-Ning Wang, Lei He, Ge Gao, Qing Zhai, Zhi-Tao Yin, Xian-Dong Zeng
Yong Zhang, Lei He, Ge Gao, Qing Zhai, Zhi-Tao Yin, Xian-Dong Zeng, Department of Constipation and Pelvic Floor Disease, Constipation Treatment Center, Shenyang Coloproctology Hospital, Shenyang 110002, Liaoning Province, China
Yong Zhang, Zhen-Ning Wang, Department of Oncology, No. 1 Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
Author contributions: Zhang Y performed the majority of the clinical therapy and data analysis, and wrote the paper; Wang ZN advised the design and performance of the study; He L and Gao G performed the follow-up and the initial data analysis; Zhai Q provided the three-dimensional endoluminal ultrasonography support; Yin ZT performed ethical supervision and provided the effect evaluation system; Zeng XD designed the study, provided the founding, and was responsible for the paper’s reliability.
Supported by Foundation of Science and Technology Plan Projects of Shenyang, No. P112238
Correspondence to: Xian-Dong Zeng, MD, PhD, Department of Constipation and Pelvic Floor Disease, Constipation Treatment Center, Shenyang Coloproctology Hospital, No. 9 Najingbei Street, Heping district, Shenyang 110002, Liaoning Province, China. zengxiandong1969@163.com
Telephone: +86-24-22511990 Fax: +86-24-22533338
Received: March 8, 2014
Revised: April 30, 2014
Accepted: June 12, 2014
Published online: September 21, 2014
Processing time: 195 Days and 10.5 Hours
Abstract

AIM: To evaluate the efficacy of botulinum toxin type A injection to the puborectalis and external sphincter muscle in the treatment of patients with anismus unresponsive to simple biofeedback training.

METHODS: This retrospective study included 31 patients suffering from anismus who were unresponsive to simple biofeedback training. Diagnosis was made by anorectal manometry, balloon expulsion test, surface electromyography of the pelvic floor muscle, and defecography. Patients were given botulinum toxin type A (BTX-A) injection and pelvic floor biofeedback training. Follow-up was conducted before the paper was written. Improvement was evaluated using the chronic constipation scoring system.

RESULTS: BTX-A injection combined with pelvic floor biofeedback training achieved success in 24 patients, with 23 maintaining persistent satisfaction during a mean period of 8.4 mo.

CONCLUSION: BTX-A injection combined with pelvic floor biofeedback training seems to be successful for intractable anismus.

Keywords: Constipation; Anismus; Biofeedback training; Obstructed outlet constipation

Core tip: Pelvic floor biofeedback was accepted to be an effective therapy for anismus. However, unfortunately the treatment proved to be ineffective in some cases. In our study, we performed biofeedback training combined with botulinum toxin type A injection to the puborectalis and external sphincter. Diagnosis was made by anorectal manometry, balloon expulsion test, surface electromyography of the pelvic floor muscle, and defecography. Follow-up was conducted before the paper was written. Improvement was evaluated using the chronic constipation scoring system. Botulinum toxin type A injection combined with pelvic floor biofeedback training achieved success in 24 (24/31) patients, with 23 maintaining persistent satisfaction during a mean period of 8.4 mo.