ABSTRACT
PURPOSE: This study came to compare the results of biofeedback retraining biofeedback (BFB), botulinum toxin botulinum type A (BTX-A) injection and partial division of puborectalis (PDPR) in the treatment of anismus patients. PATIENTS AND METHODS: Consecutive patients treated for anismus fulfilled Rome II criteria for functional constipation at our institution were evaluated for inclusion. Participants were randomly allocated to receive BFB, BTX-A injection, and PDPR. All patients underwent anorectal manometry, balloon expulsion test, defecography, and electromyography activity of the anal sphincter. Follow up was conducted weekly in the first month then monthly for about 1 year. Study variables included clinical improvement, patient satisfaction, and objective improvement. RESULTS: Sixty patients with anismus were randomized and completed the study. The groups differed significantly regarding clinical improvement at 1 month (50% for BFB, 75%BTX-A injection, and 95% for PDPR, P = 0.006) and differences persisted at 1 year (30% for BFB, 35%BTX-A injection, and 70% for PDPR, P = 0.02). Constipation score of the patients significantly improved postPDPR and BTX-A injection. Manometric relaxation was achieved significantly in the three groups. CONCLUSION: Biofeedback retraining has a limited therapeutic effect, BTX-A injection seems to be successful for temporary treatment but PDPR is found to be an effective with lower morbidity in contrast to its higher success rate in treating anismus.
Subject(s)
Anal Canal/physiopathology , Biofeedback, Psychology/methods , Botulinum Toxins, Type A/administration & dosage , Constipation/therapy , Digestive System Surgical Procedures/methods , Neuromuscular Agents/administration & dosage , Pelvic Floor/surgery , Adult , Aged , Anal Canal/surgery , Constipation/etiology , Constipation/physiopathology , Defecation/physiology , Electromyography , Female , Follow-Up Studies , Humans , Injections, Intramuscular , Male , Manometry , Middle Aged , Patient Satisfaction , Pelvic Floor/physiopathology , Prospective Studies , Treatment Outcome , Young AdultABSTRACT
PURPOSE: Anismus is a significant cause of chronic constipation. This study came to revive the results of BFB training and BTX-A injection in the treatment of anismus patients. MATERIALS AND METHODS: Forty-eight patients with anismus (33 women; mean age 39.6 +/- 15.9) were included in this study. All patients fulfilled Rome II criteria for functional constipation. All patients underwent anorectal manometry, balloon expulsion test, defecography, and electromyography (EMG) activity of the EAS. All patients had non-relaxing puborectalis muscle. The patients were randomized into two groups. Group I patients received biofeedback therapy, two times per week for about 1 month. Group II patients were injected with BTX-A. Follow-up was conducted weekly in the first month then monthly for about 1 year. RESULTS: In the BFB training group, three patients quit before the end of sessions with no improvement; initial improvement was recorded in 12 patients (50%) while long-term success was recorded in six patients (25%). In the BTX-A group, clinical improvement was recorded in 17 patients (70.83%), but the improvement persisted only in eight patients (33.3%). There is a significant difference between BTX-A group and BFB group regarding the initial success, but this significant difference disappeared at the end of follow-up. Manometric relaxation was achieved significantly post-BFB and post-BTX-A injection with no significant difference between the two groups. CONCLUSIONS: Biofeedback training has a limited therapeutic effect on patients suffering from anismus. BTX-A injection seems to be successful for temporary treatment of anismus.
Subject(s)
Anal Canal/physiopathology , Biofeedback, Psychology , Botulinum Toxins, Type A/therapeutic use , Constipation/therapy , Neuromuscular Agents/therapeutic use , Adult , Aged , Constipation/etiology , Constipation/physiopathology , Defecation/physiology , Electromyography , Female , Humans , Injections , Male , Manometry , Middle Aged , Muscle Contraction/physiology , Muscle Relaxation , Patient Satisfaction , Pelvic Floor/physiopathology , Prospective StudiesABSTRACT
OBJECTIVES: The objective of this study was to compare the results of partial division of puborectalis (PDPR) versus local botulinum toxin type A (BTX-A) injection in treating patients with anismus. PATIENTS AND METHODS: This prospective randomized study included 30 male patients suffering from anismus. Diagnosis was made by clinical examination, barium enema, colonoscopy, colonic transit time, anorectal manometry, balloon expulsion test, defecography, and electromyography. Patients were randomized into: group I which included 15 patients who were injected with BTX-A and group II which included 15 patients who underwent bilateral PDPR. Follow-up was conducted for about 1 year. Improvement was considered when patients returned to their normal habits. RESULTS: BTX-A injection achieved initial success in 13 patients (86.7%). However, long-term success persisted only in six patients (40%). This was in contrast to PDPR which achieved initial success in all patients (100%) with a long-term success in ten patients (66.6%). Recurrence was observed in seven patients (53.8%) and five patients (33.4%) following BTX-A injection and PDPR, respectively. Minor degrees of incontinence were confronted in two patients (13.3%) following PDPR. CONCLUSION: BTX-A injection seems to be successful for temporary treatment of anismus.