Botulinum toxin type-a in therapy of patients with anismus

Ron, Yishai; Avni, Yona; Lukovetski, A.; Wardi, Joram; Geva, Daniel; Birkenfeld, Shlomo; Halpern, Zamir

doi:10.1007/bf02234461

Cited by 114 publications

(58 citation statements)

References 27 publications

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“…The rationale for this practice is that the goal of most treatments for pelvic floor dyssynergia is relaxation of the striated pelvic floor muscles, whether through biofeedback, 14,19 surgical division of the puborectalis muscle, 20 or botulinum toxin injection. 21 Diazepam is a skeletal muscle relaxer, which is known to be effective in muscle spasticity, 22 and unlike the other commonly used muscle relaxer, baclofen, 23 it does not cause constipation as a side effect. Diazepam has the additional theoretical advantage that it reduces anxiety, which may contribute to pelvic floor dyssynergia in some patients.…”

Section: Designmentioning

confidence: 99%

Randomized, Controlled Trial Shows Biofeedback to be Superior to Alternative Treatments for Patients with Pelvic Floor Dyssynergia-Type Constipation

Heymen¹,

Scarlett²,

Jones³

et al. 2007

Diseases of the Colon &Amp; Rectum

267

195

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Section: Designmentioning

confidence: 99%

Randomized, Controlled Trial Shows Biofeedback to be Superior to Alternative Treatments for Patients with Pelvic Floor Dyssynergia-Type Constipation

Heymen¹,

Scarlett²,

Jones³

et al. 2007

Diseases of the Colon &Amp; Rectum

267

195

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“…28 Likewise, paralyzing the anal sphincter muscle with Botulinum toxin injections produced minimal improvement. 29 Hence, either spasm or inability to relax the external anal sphincter is unlikely to be the sole mechanism that leads to dyssynergic defecation. A prospective study, 4 showed that most patients with dyssynergic defecation demonstrate the inability to coordinate the abdominal, rectoanal and pelvic floor muscles to facilitate defecation.…”

Section: Pathophysiologymentioning

confidence: 99%

“…29,82 Injection of botulinum toxin into the anal sphincter has been tried with mixed results. 29,83 In both of these studies there was some improvement in less than one half of patients but troublesome incontinence occurred in one study. 83 Botulinum toxin seems to be useful in children.…”

Section: Other Measures For Dyssynergic Defecation Treatmentmentioning

confidence: 99%

Diagnosis and Treatment of Dyssynergic Defecation

Rao

Patcharatrakul

2016

J Neurogastroenterol Motil

180

141

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Dyssynergic defecation is common and affects up to one half of patients with chronic constipation. This acquired behavioral problem is due to the inability to coordinate the abdominal and pelvic floor muscles to evacuate stools. A detailed history, prospective stool diaries, and a careful digital rectal examination will not only identify the nature of bowel dysfunction, but also raise the index of suspicion for this evacuation disorder. Anorectal physiology tests and balloon expulsion test are essential for a diagnosis. Newer techniques such as high-resolution manometry and magnetic resonance defecography can provide mechanistic insights. Recently, randomized controlled trials have shown that biofeedback therapy is more effective than laxatives and other modalities, both in the short term and long term, without side effects. Also, symptom improvements correlated with changes in underlying pathophysiology. Biofeedback therapy has been recommended as the first-line of treatment for dyssynergic defecation. Here, we provide an overview of the burden of illness and pathophysiology of dyssynergic defecation, and how to diagnose and treat this condition with biofeedback therapy.

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“…Die Behandlung von Analschmerz mit Botulinum-Toxin führt zu uneinheitlichen Studienergebnissen, und es wird deutlich, dass nur ein Teil der Patienten, wie auch bei anderen muskulären Dystonien, auf eine Therapie mit Botulinum-Toxin anspricht [30,134]. Lediglich bei der Analfissur ist der Einsatz weitgehend anerkannt [83].…”

Section: Anismus Und Analfissurunclassified

Botulinum-Toxin in der speziellen Schmerztherapie

2003

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Botulinum toxin has been used for therapeutic purposes in medicine for more than 20 years. Its effective use now covers more than 50 conditions in a wide variety of areas. Its medicinal use was initially based on its blockade of neuromuscular and neurosecretory transfers. Its use for conditions in the field of specific pain therapy is currently authorized in Germany for spastic torticollis, blepharospasm, hemifacial spasm, spastic equine gait in cases of idiopathic cerebral paresis, and spasticity of the arm following stroke. New publications suggest that it can usefully be employed for numerous other painful conditions. The modes of action known today are not confined to the blockade of cholinergic innervation.Indeed, there is also evidence that therapeutic effects are mediated through a normalization of muscle spindle activity, retrograde intake into the CNS with modulation of the central neuropeptide function, inhibition of sterile neurogenic inflammation, and normalization of endplate dysfunction. In view of the methodological peculiarities of studies in the field of pain therapy, such as injection techniques, injection sites, blind study techniques, dosage etc., the scientific evidence for its use in a wide variety of pain syndromes is still patchy in many areas. For this reason the use of botulinum toxin for these syndromes is only justified after full use has been made of standard therapeutic methods and evaluation in specialized centers. The possibility of considering botulinum toxin in specific pain therapy contexts is a new option for patients and doctors.However, its use calls for detailed knowledge of functional neuroanatomy and extensive practical experience and expertise.

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Botulinum toxin type-a in therapy of patients with anismus

Abstract: Botox injection to the puborectalis muscle has been found to have a limited therapeutic effect on patients suffering from anismus. Our results justify the need for further double-blind placebo-controlled trials to determine the exact role of botulinum toxin type-A in anismus.

Cited by 114 publications

References 27 publications

Randomized, Controlled Trial Shows Biofeedback to be Superior to Alternative Treatments for Patients with Pelvic Floor Dyssynergia-Type Constipation

Randomized, Controlled Trial Shows Biofeedback to be Superior to Alternative Treatments for Patients with Pelvic Floor Dyssynergia-Type Constipation

Diagnosis and Treatment of Dyssynergic Defecation

Botulinum-Toxin in der speziellen Schmerztherapie

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