Intrasphincteric Botulinum Toxin Injection in Treatment of Chronic Idiopathic Constipation in Children|
Ahmadi, Javad; Azary, Saeedeh; Ashjaei, Bahar; Paragomi, Pedram & Khalifeh-Soltani, Amin
Objective: Injection of botulinum toxin into the anal sphincter is a novel and safe new treatment of chronic
idiopathic constipation and anal fissure in children. The purpose of this study was to determine the utility of
intra sphincteric injection of botox in the treatment of children with refractory constipation.
Methods: All children who suffered from chronic constipation for more than three months, and who had not
responded to medical treatment, were referred to pediatrics surgical clinic for surgical intervention by
pediatric gastroenterologist. The patients were randomly divided into cases and control group. The control
group received no injection and was only treated with stool softeners. The case group received this therapy in
addition to injection. After the botox injection, patients were asked about the presence of the signs of
constipation including painful defecation, vomiting, stool consistence, soiling and defecation interval.
Findings: Defecation of painful stool existed in 88% of patients before botox injection and it was reduced to
15% after botox injection. In the control group, 90% of patients had painful defecation, which reduced to 86%
after medical treatment (P=0.0001). Stool was hard in 80% of patients before was reduced to 28% after botox
injection. In the control group, it existed in 81% of children and reduced to 78% after medical treatment
(P=0.0001). Soiling existed in 62% of patients before and was reduced to 8% after botox injection, but in the
control group it reduced from 62 % to 42.5% after medical treatment (P=0.0001). In the control group, 98%
of the patients had defecation intervals more than 3 days and it was the same after medical treatment. In case
group, this index before botox injection was 9.1 days, and after botox injection was reduced to 2.6 days
Conclusion: Our study results showed that injection of botulinum toxin into anal sphincter is an effective and
safe new treatment of chronic idiopathic constipation in children.
Botulinum Toxin; Botox; Constipation; Defecation; Children