The Use of Botulinum Toxin as an Adjuvant in Managing Children with Chronic Constipation and Obstructed Defecation

Abstract

Background: Pediatric chronic constipation and obstructed defecation is a challenging problem, with bad impact on quality of life affecting both the child and family. It is a complex disorder of multifactorial etiology and pathophysiology. Many symptoms-based systems have been instructed for clarifying definitions for chronic constipation and obstructed defecation such as ROME IV criteria, PACCT criteria, NICE guideline. Most protocols of management of functional constipation usually include; disimpaction enemas, feeding regulations, bowel diaries and laxatives. Aim of Study:To evaluate the effectiveness of adding anal Botox injection to those already following management plan for pediatric age group suffering from chronic constipation and obstructed defecation. Patients and Methods:The current study included 40 children with functional constipation, and obstructed defecation. The study started in April 2017 and completed the patients follow-up in November 2019. Bowel management program was applied with Botulinum toxin injection. Patients were followed-up at 2 months, and 6 months using Rintala Scores. Results:The study included 45% female members and 55% male ones, with age range between 3-12 years. Improvement was achieved in 22.5% of children after 2 months of the management, all patients were followed-up at least for 6 months period, with a mean follow-up of 11.35 months. Rintala scores at initial presentation, 2 months and 6 months followup showed improvement. Overall, across all the study subjects, females did better and showed more improvement. Conclusion:This study has confirmed that BT injection did not add any significant effect, to children with obstructed defecation and chronic FC.