Botulinum-toxin-A Injection Following Conservative Management in Patients with Dyssynergic Defaecation Only Improves Symptoms in the Short Term: A Retrospective Study

 

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Abstract

Objective Dyssynergic defaecation (DD) is an important cause of chronic constipation. In patients where conservative treatments fail, injections of botulinum toxin A (BTX-A) into the puborectalis and anal sphincter muscles can be effective. Complications of this procedure are reported to be rare and generally mild. This study aimed to identify the complication rates and short- to medium-term success rates of BTX-A injections as a treatment for DD.

Methods A retrospective review was conducted on patients diagnosed with DD who had undergone BTX-A injections at a functional colorectal unit. Patient demographics, manometric assessment, conservative management, and injection technique were collected through a chart review. Subjective patient reports and comparison of pre- and postprocedure symptom scores were used to determine efficacy.

Results The 21 patients included (24 procedures, with 3 patients receiving BTX-A on two separate occasions) all received stool modification and dietary advice, and 20 patients underwent pelvic floor physiotherapy, averaging 8 sessions. The injections were universally applied under general anesthetic, primarily targeting the anal sphincter and/or puborectalis muscles. There were 6 reports of faecal urge/incontinence, with all but one being resolved within weeks.

The BTX-A injection was subjectively reported as beneficial in 19 cases, averaging 4.7 months (range 1–32) of improvement. Only 2 were sustained beyond 12 months. Despite overall improvements in symptom scores from pre- to postprocedure, none were statistically significant.

Conclusion Following a course of conservative management, the BTX-A injection appears to be a safe treatment for DD, but only has short term efficacy.

Publication History

Received: 08 November 2023

Accepted: 10 January 2024

Article published online:
11 March 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

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