Transcutaneous needle-free injection of botulinum toxin: a novel treatment of childhood constipation and anal fissure

A prospective, randomized, double-blind study comparing the efficacy of diltiazem, glyceryl trinitrate, and lidocaine for the treatment of anal fissure in children

“…AF is more common in children younger than 3 years of age than in older children. Previous studies have reported that 63-86% of children suffer soiling with a history of painful defecation until 36 months of age [4].…”

“…Several drugs are currently used to lower IAS pressure, such as calcium channel blockers, NO donors, and botulinum toxin injections, to improve tissue healing, relieve pain, and subsequently relieve constipation in patients with AF [4].…”

“…However, the role of impaired blood flow in the pathogenesis of AF is unclear. Although most reports exist in the literature the presence of an increased tone of the internal anal sphincter (IAS) represents the most reliable cause of fissuring and symptoms [1][2][3][4][5][6][7][8][9][12][13][14][15].…”

Surgical decision-making in the management of children with intractable functional constipation: What are we doing and are we doing it right?

“…Several studies, both retrospective and prospective, have shown that injection of botulinum toxin into the internal anal sphincter can be an effective treatment for these patients [28][29][30][31]. Although less commonly described, there have also been reports of successful outcomes after injection of botulinum toxin into the external anal sphincter [32,33]. Botulinum toxin causes a temporary chemical paralysis of smooth and striated muscle fibers by blocking the release of acetylcholine from neurons.…”

Constipation in children

“…We compared internal anal sphincter myectomy with intra internal anal sphincteric botulinum injection(6) finding both procedures leading to benefits in most children although we are awaiting completion of a subsequent randomised control trial of botulinum toxin. Needle free botulinum toxin injection into the external sphincter looks encouraging in pilot studies (7). In intractable cases, antegrade continence enema (ACE) stoma may be necessary in providing a route for direct medication to the colon to produce effective emptying of the megarectum.…”