Abstract
PURPOSE: Puborectalis syndrome has been difficult to treat. We investigated the efficacy of botulinum toxin in treating patients with puborectalis syndrome who had previously failed to respond to electromyographic biofeedback sessions and who refused to use anal dilators. METHODS: Of a group of 50 patients with chronic outlet obstruction constipation, four patients with puborectalis syndrome were included in the study. The patients were studied using anorectal manometry, defecography, and electromyography and then treated with 30 units of Type A botulinum toxin, injected into two sites on either side of the puborectalis muscle, under ultrasonographic guidance. RESULTS: One patient was lost to follow-up. After treatment in other patients, the frequency of natural bowel movements increased from zero to six per week and laxatives were needed by only one patient. Anorectal manometry demonstrated decreased tone during straining from (mean ± standard deviation) 96.2 ± 12 mmHg to 42.5 ± 13 mmHg at four weeks (P = 0.003) and 63.2 ± 22 mmHg at eight weeks (P = 0.009). Defecography performed eight weeks after treatment showed improvement in the anorectal angle, which increased from 94 ± 11°to 114 ± 13°(P = 0.01), and evacuation of barium paste. Electromyography demonstrated mild paradoxical contraction. However, 16 weeks after treatment one of these three patients suffered symptomatic recurrence. This patient was re-treated with 50 units of toxin; eight months later he required a further 60 units. Seven months after the last injection he reported normal daily bowel movements without the use of laxatives. CONCLUSIONS: Botulinum toxin injection should be considered as a simple therapeutic approach in patients with puborectalis syndrome. The use of higher dosage and a more precise method of toxin injections under transrectal ultrasonography account for the long-term higher success rate. However, because the effects of the toxin wear off within three months of administration, repeated injections could be necessary to maintain the clinical improvement.
| Original language | English |
|---|---|
| Pages (from-to) | 376-380 |
| Number of pages | 5 |
| Journal | Diseases of the Colon and Rectum |
| Volume | 43 |
| Issue number | 3 |
| Publication status | Published - Mar 2000 |
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Keywords
- Biofeedback
- Botulinum toxin
- Chronic constipation
- Defecation disorders
- Outlet Obstruction
- Puborectalis syndrome
ASJC Scopus subject areas
- Gastroenterology
Cite this
Botulinum toxin in the treatment of outlet obstruction constipation caused by puborectalis syndrome. / Maria, Giorgio; Brisinda, Giuseppe; Bentivoglio, Anna Rita; Cassetta, Emanuele; Albanese, Alberto.
In: Diseases of the Colon and Rectum, Vol. 43, No. 3, 03.2000, p. 376-380.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Botulinum toxin in the treatment of outlet obstruction constipation caused by puborectalis syndrome
AU - Maria, Giorgio
AU - Brisinda, Giuseppe
AU - Bentivoglio, Anna Rita
AU - Cassetta, Emanuele
AU - Albanese, Alberto
PY - 2000/3
Y1 - 2000/3
N2 - PURPOSE: Puborectalis syndrome has been difficult to treat. We investigated the efficacy of botulinum toxin in treating patients with puborectalis syndrome who had previously failed to respond to electromyographic biofeedback sessions and who refused to use anal dilators. METHODS: Of a group of 50 patients with chronic outlet obstruction constipation, four patients with puborectalis syndrome were included in the study. The patients were studied using anorectal manometry, defecography, and electromyography and then treated with 30 units of Type A botulinum toxin, injected into two sites on either side of the puborectalis muscle, under ultrasonographic guidance. RESULTS: One patient was lost to follow-up. After treatment in other patients, the frequency of natural bowel movements increased from zero to six per week and laxatives were needed by only one patient. Anorectal manometry demonstrated decreased tone during straining from (mean ± standard deviation) 96.2 ± 12 mmHg to 42.5 ± 13 mmHg at four weeks (P = 0.003) and 63.2 ± 22 mmHg at eight weeks (P = 0.009). Defecography performed eight weeks after treatment showed improvement in the anorectal angle, which increased from 94 ± 11°to 114 ± 13°(P = 0.01), and evacuation of barium paste. Electromyography demonstrated mild paradoxical contraction. However, 16 weeks after treatment one of these three patients suffered symptomatic recurrence. This patient was re-treated with 50 units of toxin; eight months later he required a further 60 units. Seven months after the last injection he reported normal daily bowel movements without the use of laxatives. CONCLUSIONS: Botulinum toxin injection should be considered as a simple therapeutic approach in patients with puborectalis syndrome. The use of higher dosage and a more precise method of toxin injections under transrectal ultrasonography account for the long-term higher success rate. However, because the effects of the toxin wear off within three months of administration, repeated injections could be necessary to maintain the clinical improvement.
AB - PURPOSE: Puborectalis syndrome has been difficult to treat. We investigated the efficacy of botulinum toxin in treating patients with puborectalis syndrome who had previously failed to respond to electromyographic biofeedback sessions and who refused to use anal dilators. METHODS: Of a group of 50 patients with chronic outlet obstruction constipation, four patients with puborectalis syndrome were included in the study. The patients were studied using anorectal manometry, defecography, and electromyography and then treated with 30 units of Type A botulinum toxin, injected into two sites on either side of the puborectalis muscle, under ultrasonographic guidance. RESULTS: One patient was lost to follow-up. After treatment in other patients, the frequency of natural bowel movements increased from zero to six per week and laxatives were needed by only one patient. Anorectal manometry demonstrated decreased tone during straining from (mean ± standard deviation) 96.2 ± 12 mmHg to 42.5 ± 13 mmHg at four weeks (P = 0.003) and 63.2 ± 22 mmHg at eight weeks (P = 0.009). Defecography performed eight weeks after treatment showed improvement in the anorectal angle, which increased from 94 ± 11°to 114 ± 13°(P = 0.01), and evacuation of barium paste. Electromyography demonstrated mild paradoxical contraction. However, 16 weeks after treatment one of these three patients suffered symptomatic recurrence. This patient was re-treated with 50 units of toxin; eight months later he required a further 60 units. Seven months after the last injection he reported normal daily bowel movements without the use of laxatives. CONCLUSIONS: Botulinum toxin injection should be considered as a simple therapeutic approach in patients with puborectalis syndrome. The use of higher dosage and a more precise method of toxin injections under transrectal ultrasonography account for the long-term higher success rate. However, because the effects of the toxin wear off within three months of administration, repeated injections could be necessary to maintain the clinical improvement.
KW - Biofeedback
KW - Botulinum toxin
KW - Chronic constipation
KW - Defecation disorders
KW - Outlet Obstruction
KW - Puborectalis syndrome
UR - http://www.scopus.com/inward/record.url?scp=0034018827&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0034018827&partnerID=8YFLogxK
M3 - Article
C2 - 10733120
AN - SCOPUS:0034018827
VL - 43
SP - 376
EP - 380
JO - Diseases of the Colon and Rectum
JF - Diseases of the Colon and Rectum
SN - 0012-3706
IS - 3
ER -