Botulinum Toxin Injection in Children with Constipation Caused by Internal anal Sphincter Achalasia

Background and

To determine the effect of intrasphincteric botulinum toxin injection to treat internal anal sphincter achalasia.

Twenty patients (11 boys, average age 4.95± 2.47 years) with definite diagnosis of internal anal sphincter achalasia received 20 units of botulinum toxin injection in 4 points of the internal anal sphincter (totally 80 units). Then during 8 months of follow up visits, profile and response to treatment and bowel movements criteria of the patients were recorded in a questionnaire

All patients except one had treatment response. On 1-month follow-up, response to treatment was excellent in 35% of patients, and average in 60%. Response to treatment after 8 months follow-up was excellent in 50% and average in 40% and 10% was poor. The effect of botulinum toxin in 14 patients continued by the end of follow-up, and in 5 patients lasted between 7 to 20 weeks. The therapeutic response of these people, except one, remained moderate. Transient fecal incontinency was the only complication observed in 3 patients that was resolved after 1 to 3 weeks.

Injection of botulinum toxin into the internal anal sphincter is an effective and safe method of treatment for achalasia, with long lasting results and few transient complications.