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

Authors

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