International Journal of Colorectal Disease

, Volume 24, Issue 3, pp 327–334

Comparative study between botulinum toxin injection and partial division of puborectalis for treating anismus


  • Mohamed Farid
    • Mansoura Faculty of Medicine
    • Mansoura Faculty of MedicineMansoura University Hospital
    • Department of SurgeryMansoura University Hospital
  • Tarek Mahdy
    • Mansoura Faculty of Medicine
  • Waleed Omar
    • Mansoura Faculty of Medicine
  • Hesham Abdul Moneim
    • Mansoura Faculty of Medicine
  • Ayman El_Nakeeb
    • Mansoura Faculty of Medicine
  • Mohamed Youssef
    • Mansoura Faculty of Medicine
Original Article

DOI: 10.1007/s00384-008-0609-7

Cite this article as:
Farid, M., Youssef, T., Mahdy, T. et al. Int J Colorectal Dis (2009) 24: 327. doi:10.1007/s00384-008-0609-7



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.


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.


BTX-A injection seems to be successful for temporary treatment of anismus.


ConstipationAnismusPuborectalis syndromeObstructed defecation

Copyright information

© Springer-Verlag 2008