International Journal of Colorectal Disease

, Volume 24, Issue 1, pp 115–120

Comparative study between biofeedback retraining and botulinum neurotoxin in the treatment of anismus patients

  • Mohamed Farid
  • Hisham Abd El Monem
  • Waleed Omar
  • Ayman El Nakeeb
  • Amir Fikry
  • Tamer Youssef
  • Mohamed Yousef
  • Hosam Ghazy
  • Elyamani Fouda
  • Teto El Metwally
  • Wael Khafagy
  • Sabry Ahmed
  • Salih El Awady
  • Mosaad Morshed
  • Ramadan El Lithy
Original Article

DOI: 10.1007/s00384-008-0567-0

Cite this article as:
Farid, M., El Monem, H.A., Omar, W. et al. Int J Colorectal Dis (2009) 24: 115. doi:10.1007/s00384-008-0567-0

Abstract

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.

Keywords

Obstructed defecationChronic constipationPuborectalisPelvic floor

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Mohamed Farid
    • 1
  • Hisham Abd El Monem
    • 1
  • Waleed Omar
    • 1
  • Ayman El Nakeeb
    • 1
  • Amir Fikry
    • 1
  • Tamer Youssef
    • 1
  • Mohamed Yousef
    • 1
  • Hosam Ghazy
    • 1
  • Elyamani Fouda
    • 1
  • Teto El Metwally
    • 1
  • Wael Khafagy
    • 1
  • Sabry Ahmed
    • 1
  • Salih El Awady
    • 1
  • Mosaad Morshed
    • 1
  • Ramadan El Lithy
    • 1
  1. 1.General Surgery Department, Dep. 8 and Colorectal UnitMansoura University HospitalMansouraEgypt