Rebooting the anal sphincter: A retrospective cohort of children with intractable constipation receiving intrasphincteric botox injections

Background

Chronic childhood constipation is a common problem that severely impacts quality of life. Recently, the efficacy of intrasphincteric botulinum toxin (botox) injection in breaking the cycle of constipation has been demonstrated. The current study aims to investigate response rate to treatment, symptom and examination finding associations, and identify associations between patient characteristics and outcome.

Methods

Parental consent was given for the review of medical records. This retrospective cohort included paediatric patients, under 16 years old, presenting to Perth Paediatrics, in Western Australia, from August 2017 to June 2022, who received botox injections (10 IU/kg, at 3, 6, and 9 o'clock) for intractable constipation. Patients required a negative diagnosis of Hirschsprung's disease for inclusion. A successful outcome was defined by a reduction in related symptoms and dosage of aperients at a post-operative consultation at least two weeks following injection, compared to those prior.

Results

Of 81 patients, 83 % experienced an overall improvement in symptoms following their first injection. 47 % noted a reduced laxative requirement, with no patients reporting any adverse effects. Twelve patients received a second injection, of which 58 % reported a successful outcome afterward. Across all variables, the majority of patients experienced a positive response. In this retrospective cohort, there were no associations demonstrated between comorbidities, age, sex, symptomatology, or examination findings, and positive response.

Conclusions

These results suggest that, in managing intractable constipation in children, intrasphincteric botox injection may be beneficial in reducing symptoms, with no reported adverse events in this cohort.