Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2024; 12(22): 4905-4912
Published online Aug 6, 2024. doi: 10.12998/wjcc.v12.i22.4905
Botulinum toxin type A injection combined with biofeedback in the treatment of spastic pelvic floor syndrome
Fei-Fei Sun, Yong-Qiang Chen, Zong-Lin Jiang, Lin Ma
Fei-Fei Sun, Yong-Qiang Chen, Zong-Lin Jiang, Lin Ma, Department of Anorectal Surgery, The Eighth People's Hospital of Qingdao, Qingdao 266000, Shandong Province, China
Co-first authors: Fei-Fei Sun and Yong-Qiang Chen.
Co-corresponding authors: Fei-Fei Sun and Lin Ma.
Author contributions: Sun FF first proposed the idea of the paper; Ma L designed the study, organized the logic of the paper, and put forward suggestions in several revisions; Ma L managed and coordinated the whole process of the project; Sun FF searched the literature, and revised and submitted an earlier version of the manuscript; Chen YQ screened the patients, obtained the clinical data and analyzed the data, and revised the manuscript many times; Jiang ZL collected the data and related pictures needed for the article, organized and revised it; Sun FF and Chen YQ co-wrote the article; All authors read and approved the final draft. The two authors made crucial and indispensable contributions to the interpretation of experimental design data and the completion of the project, so they are qualified as the co-corresponding authors of the paper.
Institutional review board statement: This study has been reviewed and approved by the hospital ethics committee.
Informed consent statement: Patients were informed and consented to the study and publication of the results.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: Data for our study were obtained from internal hospital systems and permitted through internal hospital databases. No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fei-Fei Sun, MD, Occupational Physician, Department of Anorectal Surgery, The Eighth People's Hospital of Qingdao, No. 84 Fengshan Road, Licang District, Qingdao 266000, Shandong Province, China. sunfeifei0717@sina.com
Received: February 24, 2024
Revised: May 12, 2024
Accepted: June 13, 2024
Published online: August 6, 2024
Processing time: 128 Days and 21 Hours
Abstract
BACKGROUND

Spastic pelvic floor syndrome (SPFS) is a refractory pelvic floor disease characterized by abnormal (uncoordinated) contractions of the external anal sphincter and puborectalis muscle during defecation, resulting in rectal emptation and obstructive constipation. The clinical manifestations of SPFS are mainly characterized by difficult defecation, often accompanied by a sense of anal blockage and drooping. Manual defecation is usually needed during defecation. From physical examination, it is commonly observed that the patient's anal muscle tension is high, and it is difficult or even impossible to enter with his fingers.

AIM

To investigate the characteristics of anorectal pressure and botulinum toxin A injection combined with biofeedback in treating pelvic floor muscle spasm syndrome.

METHODS

Retrospective analysis of 50 patients diagnosed with pelvic floor spasm syndrome. All patients underwent pelvic floor surface electromyography assessment, anorectal dynamics examination, botulinum toxin type A injection 100 U intramuscular injection, and two cycles of biofeedback therapy.

RESULTS

After the botulinum toxin A injection combined with two cycles of biofeedback therapy, the patient's postoperative resting and systolic blood pressure were significantly lower than before surgery (P < 0.05). Moreover, the electromyography index of the patients in the resting stage and post-resting stages was significantly lower than before surgery (P < 0.05).

CONCLUSION

Botulinum toxin A injection combined with biofeedback can significantly reduce pelvic floor muscle tension in treating pelvic floor muscle spasm syndrome. Anorectal manometry is an effective method to evaluate the efficacy of treatment objectively. However, randomized controlled trials are needed.

Keywords: Spastic pelvic floor syndrome, Botulinum toxin A, Biofeedback, Anorectal pressure measurement, Agachan constipation score

Core Tip: In this study, a retrospective analysis was conducted on 50 patients diagnosed with pelvic floor spasm syndrome who received injections of type A botulinum toxin and underwent two cycles of biofeedback therapy. After treatment, the patients' postoperative resting pressure and systolic pressure were significantly lower than those before surgery, and the electromyogram index during resting and after resting was significantly lower than before surgery. Type A botulinum toxin injection combined with biofeedback therapy can significantly reduce the tension of the pelvic floor muscles in treating pelvic floor muscle spasm syndrome.