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 pathophysi-ology. Many symptoms-based systems have been instructed for clarifying definitions for chronic constipation and obstruct-ed 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 defeca-tion. 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. Improve-ment 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 follow-up 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.