Anterior rectocele due to obstructed defecation relieved by botulinum toxin

Giorgio Maria, Giuseppe Brisinda, Anna Rita Bentivoglio, Alberto Albanese, Gabriele Sganga, Marco Castagneto

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background. Surgical repair of rectocele does not always alleviate symptoms related to difficulty in defecation, and some patients have impaired fecal continence after surgical treatment. To avoid complications of surgical repair, we investigated the efficacy of botulinum toxin in treating patients with symptomatic rectocele. Methods. Fourteen female patients with anterior rectocele were included in the study. The patients were studied by using anorectal manometry and defecography, and then treated with a total of 30 units of type A botulinum toxin, injected into 3 sites, 2 on either side of the puborectalis muscle and the third anteriorly in the external anal sphincter, under ultrasonographic guidance. Results. After 2 months, symptomatic improvement was noted in 9 patients (P = .0003). At the same time, rectocele depth (mean ± SD) was reduced from 4.3 ± 0.6 cm to 1.8 ± 0.5 cm (P = .0000001) and rectocele area from 9.2 ± 1.3 cm2 to 2.8 ± 1.6 cm2 (P = .0000001). Anorectal manometry demonstrated decreased tone during straining from 70 ± 28 mm Hg at baseline to 41 ± 19 mm Hg at 1 month (P = .003) and to 41 ± 22 mm Hg at 2 months (P = .005). No permanent complications were observed in any patient for a mean follow-up period of 18 ± 4 months. At 1 year evaluation, incomplete or digitally assisted rectal voiding was not reported by any patient, and a rectocele was not found at physical examination. Four recurrent, asymptomatic rectoceles were noted at defecography. Conclusions. Botulinum toxin injections should be considered as a simple therapeutic approach in patients with anterior rectocele. The treatment is safe and less expensive than surgical repair. A more precise method of toxin injections under transrectal ultrasonography accounts for the high success rate. Repeated injections may be necessary to maintain the clinical improvement.

Original languageEnglish
Pages (from-to)524-529
Number of pages6
JournalSurgery
Volume129
Issue number5
DOIs
Publication statusPublished - 2001

Fingerprint

Rectocele
Defecation
Botulinum Toxins
Defecography
Manometry
Injections
Type A Botulinum Toxins
Anal Canal
Physical Examination
Ultrasonography
Therapeutics
Muscles

ASJC Scopus subject areas

  • Surgery

Cite this

Maria, G., Brisinda, G., Bentivoglio, A. R., Albanese, A., Sganga, G., & Castagneto, M. (2001). Anterior rectocele due to obstructed defecation relieved by botulinum toxin. Surgery, 129(5), 524-529. https://doi.org/10.1067/msy.2001.112737

Anterior rectocele due to obstructed defecation relieved by botulinum toxin. / Maria, Giorgio; Brisinda, Giuseppe; Bentivoglio, Anna Rita; Albanese, Alberto; Sganga, Gabriele; Castagneto, Marco.

In: Surgery, Vol. 129, No. 5, 2001, p. 524-529.

Research output: Contribution to journalArticle

Maria, G, Brisinda, G, Bentivoglio, AR, Albanese, A, Sganga, G & Castagneto, M 2001, 'Anterior rectocele due to obstructed defecation relieved by botulinum toxin', Surgery, vol. 129, no. 5, pp. 524-529. https://doi.org/10.1067/msy.2001.112737
Maria, Giorgio ; Brisinda, Giuseppe ; Bentivoglio, Anna Rita ; Albanese, Alberto ; Sganga, Gabriele ; Castagneto, Marco. / Anterior rectocele due to obstructed defecation relieved by botulinum toxin. In: Surgery. 2001 ; Vol. 129, No. 5. pp. 524-529.
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abstract = "Background. Surgical repair of rectocele does not always alleviate symptoms related to difficulty in defecation, and some patients have impaired fecal continence after surgical treatment. To avoid complications of surgical repair, we investigated the efficacy of botulinum toxin in treating patients with symptomatic rectocele. Methods. Fourteen female patients with anterior rectocele were included in the study. The patients were studied by using anorectal manometry and defecography, and then treated with a total of 30 units of type A botulinum toxin, injected into 3 sites, 2 on either side of the puborectalis muscle and the third anteriorly in the external anal sphincter, under ultrasonographic guidance. Results. After 2 months, symptomatic improvement was noted in 9 patients (P = .0003). At the same time, rectocele depth (mean ± SD) was reduced from 4.3 ± 0.6 cm to 1.8 ± 0.5 cm (P = .0000001) and rectocele area from 9.2 ± 1.3 cm2 to 2.8 ± 1.6 cm2 (P = .0000001). Anorectal manometry demonstrated decreased tone during straining from 70 ± 28 mm Hg at baseline to 41 ± 19 mm Hg at 1 month (P = .003) and to 41 ± 22 mm Hg at 2 months (P = .005). No permanent complications were observed in any patient for a mean follow-up period of 18 ± 4 months. At 1 year evaluation, incomplete or digitally assisted rectal voiding was not reported by any patient, and a rectocele was not found at physical examination. Four recurrent, asymptomatic rectoceles were noted at defecography. Conclusions. Botulinum toxin injections should be considered as a simple therapeutic approach in patients with anterior rectocele. The treatment is safe and less expensive than surgical repair. A more precise method of toxin injections under transrectal ultrasonography accounts for the high success rate. Repeated injections may be necessary to maintain the clinical improvement.",
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AU - Maria, Giorgio

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AU - Sganga, Gabriele

AU - Castagneto, Marco

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N2 - Background. Surgical repair of rectocele does not always alleviate symptoms related to difficulty in defecation, and some patients have impaired fecal continence after surgical treatment. To avoid complications of surgical repair, we investigated the efficacy of botulinum toxin in treating patients with symptomatic rectocele. Methods. Fourteen female patients with anterior rectocele were included in the study. The patients were studied by using anorectal manometry and defecography, and then treated with a total of 30 units of type A botulinum toxin, injected into 3 sites, 2 on either side of the puborectalis muscle and the third anteriorly in the external anal sphincter, under ultrasonographic guidance. Results. After 2 months, symptomatic improvement was noted in 9 patients (P = .0003). At the same time, rectocele depth (mean ± SD) was reduced from 4.3 ± 0.6 cm to 1.8 ± 0.5 cm (P = .0000001) and rectocele area from 9.2 ± 1.3 cm2 to 2.8 ± 1.6 cm2 (P = .0000001). Anorectal manometry demonstrated decreased tone during straining from 70 ± 28 mm Hg at baseline to 41 ± 19 mm Hg at 1 month (P = .003) and to 41 ± 22 mm Hg at 2 months (P = .005). No permanent complications were observed in any patient for a mean follow-up period of 18 ± 4 months. At 1 year evaluation, incomplete or digitally assisted rectal voiding was not reported by any patient, and a rectocele was not found at physical examination. Four recurrent, asymptomatic rectoceles were noted at defecography. Conclusions. Botulinum toxin injections should be considered as a simple therapeutic approach in patients with anterior rectocele. The treatment is safe and less expensive than surgical repair. A more precise method of toxin injections under transrectal ultrasonography accounts for the high success rate. Repeated injections may be necessary to maintain the clinical improvement.

AB - Background. Surgical repair of rectocele does not always alleviate symptoms related to difficulty in defecation, and some patients have impaired fecal continence after surgical treatment. To avoid complications of surgical repair, we investigated the efficacy of botulinum toxin in treating patients with symptomatic rectocele. Methods. Fourteen female patients with anterior rectocele were included in the study. The patients were studied by using anorectal manometry and defecography, and then treated with a total of 30 units of type A botulinum toxin, injected into 3 sites, 2 on either side of the puborectalis muscle and the third anteriorly in the external anal sphincter, under ultrasonographic guidance. Results. After 2 months, symptomatic improvement was noted in 9 patients (P = .0003). At the same time, rectocele depth (mean ± SD) was reduced from 4.3 ± 0.6 cm to 1.8 ± 0.5 cm (P = .0000001) and rectocele area from 9.2 ± 1.3 cm2 to 2.8 ± 1.6 cm2 (P = .0000001). Anorectal manometry demonstrated decreased tone during straining from 70 ± 28 mm Hg at baseline to 41 ± 19 mm Hg at 1 month (P = .003) and to 41 ± 22 mm Hg at 2 months (P = .005). No permanent complications were observed in any patient for a mean follow-up period of 18 ± 4 months. At 1 year evaluation, incomplete or digitally assisted rectal voiding was not reported by any patient, and a rectocele was not found at physical examination. Four recurrent, asymptomatic rectoceles were noted at defecography. Conclusions. Botulinum toxin injections should be considered as a simple therapeutic approach in patients with anterior rectocele. The treatment is safe and less expensive than surgical repair. A more precise method of toxin injections under transrectal ultrasonography accounts for the high success rate. Repeated injections may be necessary to maintain the clinical improvement.

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