Comparative study between biofeedback retraining and botulinum neurotoxin in treatment of anismus patients

ABSTRACT

Anismus is a significant cause of chronic constipation. This study came to revive the results of biofeedback BFB retraining and botulinum toxin A BTX- A injection in treatment of anismus patients. Forty eight patients with history of constipation underwent anorectal manometry, balloon expulsion, defecography, and electromyography. All patients had a non relaxing puoborectalis muscle. The patients were randomized into 2 groups. Group I patients receive biofeedback, two times per week for one month. Group II patients were injected with BTX- A. Follow up was conducted weekly in the first month then monthly for one year. In BFB training group 3 patients quite before the end of sessions with no improvement, initial improvement was recorded in 12 patients [50%] while long term success was recorded in 6 patients [25%]. In BTX-A group, initial improvement recorded in 17 patients [70.83%] with long term improvement in 8 patients [33.3%] There is a significant difference between BTX-A group and BFB group as regarding the initial success, but this significant difference disappeared at the end of follow up. Biofeedback retraining has therapeutic effect on patients suffering from anismus also, BTX-A injection is successful for temporary treatment of anismus and need repeated injection. Initial improvement is better after BTX-A injection