대한대장항문학회

PURPOSE: Paradoxical puborectalis contraction (PPC) or Anismus is known to have a pathogenesis of abnormal contraction of puborectalis at defecation and its managements are not satisfactory. Recently, therapy of PPC and its associated symptoms using<br>Botulinum toxin-A (BTX-A) has been introduced. we evaluate the effect of BTX-A injection to the puborectalis for the patients with PPC. METHODS: Fourteen patients were diagnosed as paradoxical puborectalis contraction on defecography and/or anorectal<br>manometry and electromyography (EMG) during September 1998 to January 2001 in Daegu Catholic Medical Centre, Catholic University of Daegu. All patients were underwent 30 (15+15) units of BTX-A injection on each side of puborectalis guided by EMG. Among<br>them, five patients needed further injection of 20 (10+10) units because the expected results were not satisfied. Follow-up were conducted on one month and one year after BTX-A injection and the patients were assessed for the constipation score and<br>anorectal manometry. RESULTS: After injection of BTX-A, constipation score was significantly decreased from 15.5+/-3.5 (mean+/-SD) to 5.7+/-4.3. Maximal resting and squeezing pressure also decreased from 48.4+/-22 mmHg, 96.9+/-39.8 to 41.2+/-17,<br>68.3+/-38.2, respectively. Twelve patients who were followed up more than one year after injection, the constipation score (n=12) increased up to 7.7+/-2.9 (mean+/-SD). Among them, three patients have had stool softeners or laxatives to evacuate and the<br>remained nine patients did not have any kinds of drug or food for defecation. There was no complication for the injection BTX-A. CONCLUSIONS: BTX-A injection seems to be effective for the treatment of PPC and the long term therapeutic effect can be<br>defined through double blind placebo-controlled trials.<br>