Brisinda Giuseppe, Fico Valeria, Tropeano Giuseppe, Cariati Maria, Altieri Gaia, Misuriello Filomena, Pepe Gilda, Fransvea Pietro, Chiarello Maria Michela
Catholic School of Medicine, "Agostino Gemelli", 00168, Rome, Italy.
Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli, IRCCS, 00168, Rome, Italy.
Int J Colorectal Dis. 2025 Jan 21;40(1):22. doi: 10.1007/s00384-024-04795-5.
Chronic constipation is a common symptom. Constipation due to pelvic floor disorders remain a therapeutic challenge. Biofeedback therapy is considered as the first-choice treatment for pelvic floor disorders, whenever dedicated expertise is available. Type A botulinum toxin has been used to selectively weaken the external anal sphincter and puborectalis muscle in constipated patients.
Eighty-two patients with chronic outlet obstruction constipation were treated with 100 units type A botulinum toxin, injected into the puborectalis muscle and the external anal sphincter.
At the 2-month evaluation, a symptomatic improvement was noted in 69 patients. Seven (8.5%) patients had mild flatus incontinence. Stool frequency per week increased from 2.4 ± 0.9 to 5.1 ± 1.0 (P = 0.0001). Anorectal manometry demonstrated decreased tone during straining from 91 ± 28 mmHg to 61 ± 27 mmHg (P = 0.0001). Defecography after the treatment showed improvement in anorectal angle during straining, which increased from 96 ± 12° to 124 ± 14° (P = 0.0001).
Type A botulinum toxin relaxes the puborectalis muscle. Pressure values decline after the treatment. Transrectal ultrasonography to guide injections is a safe procedure. Repeated injections were needed to maintain the clinical improvement.
慢性便秘是一种常见症状。盆底功能障碍所致便秘仍是一个治疗难题。只要有专业技术人员，生物反馈疗法被认为是盆底功能障碍的首选治疗方法。A型肉毒毒素已被用于选择性地减弱便秘患者的肛门外括约肌和耻骨直肠肌。
82例慢性出口梗阻型便秘患者接受100单位A型肉毒毒素治疗，将其注射到耻骨直肠肌和肛门外括约肌。
在2个月的评估中，69例患者症状改善。7例（8.5%）患者有轻度排气失禁。每周排便次数从2.4±0.9次增加到5.1±1.0次（P = 0.0001）。肛门直肠测压显示用力排便时张力从91±28mmHg降至61±27mmHg（P = 0.0001）。治疗后的排粪造影显示用力排便时肛门直肠角改善，从96±12°增加到124±14°（P = 0.0001）。
A型肉毒毒素可松弛耻骨直肠肌。治疗后压力值下降。经直肠超声引导注射是一种安全的操作。需要重复注射以维持临床改善。
