Can botulinum toxin help in managing children with functional constipation and obstructed defecation?

Radwan, Ahmed; GadAllah, Mohamed Abdel Sattar; Shahawy, Mohammed R.; Al-Bagdady, Ayman; Talaat, Ahmed

doi:10.1016/j.jpedsurg.2020.06.044

Cited by 9 publications

(4 citation statements)

References 15 publications

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“…8 16 A recently-published randomized trial evaluated the effect of the addition of BTI to conventional treatment, including dietary advice, toilet training, and senna-based laxatives. 17 They included 40 children with FC at a tertiary center and found no additional benefit of the BTI on Rintala severity scores. However, the Rintala score is developed not to represent constipation severity, but rather to reflect the continence levels of the subject, with higher scores reflecting better continence levels.…”

Section: Discussionmentioning

confidence: 99%

Anal Botulinum Toxin in Children with Hirschsprung Disease and Functional Constipation: A Prospective Cohort study

et al. 2022

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Introduction Anal sphincter botulinum toxin injections (BTIs) are used in the treatment of children with severe defecation disorders, including Hirschsprung disease (HD) and functional constipation (FC). Our objective was to evaluate the outcomes of BTI in these children. Materials and Methods We performed a prospective cohort study of children undergoing BTI from July 2018 to December 2018. We recorded perceived effect of the BTI, including effectiveness ranging from 0 (not at all effective) to 4 (extremely effective). In addition, we recorded symptoms and the Cleveland Clinic Constipation Score (CCCS). Data were collected at baseline and at 2 weeks, 2 months, and 4 months post-injection. Results Forty-two children (HD = 25, FC = 17) were included in the study (median age 4.3 years, IQR 2.4–7.2, 52% male). Twenty-two (88%) children with HD and eight (47%) children with FC had previously undergone a BTI. BTIs were perceived effective in 16 (76%) and 12 (71%) children with HD and eight (47%) and seven (47%) children with FC at 2-week and 2-month follow-up, respectively. Effectiveness was not rated differently between groups except at the 2-month follow-up, when patients with HD rated the BTI more effective compared to those with FC (median 2 [HD] vs. median 1 [FC], p = 0.022). Over the course of the study, 17/39 (44%) children reported self-limiting adverse effects such as fecal incontinence and pain at the injection site. Conclusion Anal sphincter BTIs can be effective in the treatment of constipation in both HD and FC patients.

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Section: Discussionmentioning

confidence: 99%

Anal Botulinum Toxin in Children with Hirschsprung Disease and Functional Constipation: A Prospective Cohort study

et al. 2022

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“…This was a non-randomized non-controlled study with a small FC population ( n = 17), so these results should be interpreted with great care. A recent randomized controlled study included 40 pediatric patients with FC (according to Rome IV criteria) with obstruction defecation syndrome (according to the National Institute for Health and Care Excellence definition) [ 113 ]. The study explored the role of a BTI as an addition to conventional treatment for FC, which consisted of a modified diet, toilet training, and stimulant laxatives.…”

Section: Botulinum Toxin Injection (Botox ® )mentioning

confidence: 99%

“…The study explored the role of a BTI as an addition to conventional treatment for FC, which consisted of a modified diet, toilet training, and stimulant laxatives. The authors concluded that the addition of a BTI did not result in significant improvement of defecatory problems assessed by the Rintala score [ 113 ]. However, it should be considered that the Rintala score is established to evaluate fecal continence and it does not necessarily reflect constipation severity.…”

Section: Botulinum Toxin Injection (Botox ® )mentioning

confidence: 99%

An Update of Pharmacological Management in Children with Functional Constipation

et al. 2023

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Functional constipation is a common problem in childhood worldwide and has a great impact on social, physical, and emotional functioning of affected children and their caregivers. It is a clinical diagnosis based on the Rome IV criteria. Nonpharmacological treatment involves education, demystification, lifestyle advice, and toilet training. Pharmacological treatment consists of disimpaction, maintenance treatment, and eventually weaning if possible. Polyethylene glycol is considered as the first choice of laxative for both disimpaction and maintenance treatment. Different osmotic laxatives, stimulant laxatives, lubricants, and enemas are available as alternative pharmacological treatment options. Novel drugs are emerging but evidence to support the widespread application of these drugs in the pediatric population is often lacking and more high-quality research is needed in this field. If children remain symptomatic despite optimal pharmacological treatment, botulinum toxin injections in the anal sphincter can be considered as an alternative, more invasive treatment option. This review provides an update on currently available literature concerning the pharmacologic treatment of functional constipation in children.

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“…Primary outcome measures were AMCP, ALCT, RRP, and ARP. The clinical outcome was evaluated by the RBFS (1,12,13).…”

Section: Outcome Measurementmentioning

confidence: 99%

The Efficacy of Biofeedback Therapy for the Treatment of Fecal Incontinence After Soave Procedure in Children for Hirschsprung's Disease

Yuan

Yang

et al. 2021

Front. Pediatr.

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Introduction: Hirschsprung's disease is a common digestive tract malformation in children, and the Soave procedure is one of the classic surgical methods for Hirschsprung's disease (HD). Fecal incontinence is one of the most common postoperative complications that can cause significant distress to the patients and their family, the incidence of which is 20% in a recent series. Biofeedback therapy (BFT) can be an effective treatment for managing anorectal disorders, but there has been little report of the efficacy of BFT for the treatment of fecal incontinence after the Soave procedure, and the main objective of this study is to evaluate it.Methods: We retrospectively analyzed postoperative fecal incontinence in 46 children who received the Soave procedure for HD and who received BFT at our institution from March 2016 to February 2020, which included 38 males and 8 females (mean age 8.1 years, from 3.7 to 14 years). Anal sphincter contraction training was performed using BFT for 10 days per session in the hospital, one time each day, and 20 min each time. BFT was performed by employing visual and verbal feedback techniques using the biofeedback instrument. Long-term functional outcomes were objectively assessed using the Rintala Bowel Function Score (RBFS), and the patients were scored according to the sum total as excellent (18–20 points, 0 case), good (11–16 points, 0 case), fair (9–11 points, 9 cases), or poor (6–9 points, 37 cases). Defecation questionnaires and anorectal manometry were completed pretreatment and after three, six, or nine sessions, and primary outcome measures of anorectal manometry were anal maximal contraction pressure (AMCP), anal longest contraction time (ALCT), rectal rest pressure (RRP), and anal rest pressure (ARP).Results: Followed up from 6 months to 4 years, the symptoms of fecal incontinence disappeared completely in 39 (84.78%) patients. Among them, 14 (30.43%) had complete disappearance of symptoms after 3 sessions of treatment, 25 (54.34%) patients had improved symptoms after 6 sessions of treatment, symptoms completely disappeared after 6 sessions of treatment, and 7 (15.22%) cases still suffered fecal incontinence mildly. The AMCP after three and six sessions in the poor group was significantly increased compared with that before treatment [(85.87 ± 31.75) mmHg vs. (135.33 ± 37.69) mmHg vs. (128.41 ± 33.45) mmHg, P < 0.05]. The ALCT and ARP showed the same trend, while the RRP after three and six sessions were not significant (P > 0.05). The mean (±SD) score of the RBFS increased from 9 to 17.40 ± 0.84 in the fair group, while it increased from 7.22 ± 0.76 to 16.58 ± 1.66 in the poor group after six sessions (P < 0.05).Conclusion: Biofeedback therapy is a safe and effective treatment of fecal incontinence after the Soave procedure of children for Hirschsprung's disease. It is beneficial to design the individualized treatment programs for the children with varying degrees of fecal incontinence.

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Can botulinum toxin help in managing children with functional constipation and obstructed defecation?

Cited by 9 publications

References 15 publications

Anal Botulinum Toxin in Children with Hirschsprung Disease and Functional Constipation: A Prospective Cohort study

Anal Botulinum Toxin in Children with Hirschsprung Disease and Functional Constipation: A Prospective Cohort study

An Update of Pharmacological Management in Children with Functional Constipation

The Efficacy of Biofeedback Therapy for the Treatment of Fecal Incontinence After Soave Procedure in Children for Hirschsprung's Disease

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