LAUSR

Botulinum toxin type A is a biochemical neuromodulator known to block cholinergic transmission at the neuromuscular junction. Over the last two decades, the localised efficacy of botulinum toxin A, and its well-tolerated safety profile, have resulted in a significant growth of its onand off-label use across multiple therapeutic and aesthetic indications [1]. It has also been shown to be effective in the gastrointestinal tract [2–4]. Until now, injections of botulinum toxin have been used in the treatment of, inter alia, chronic idiopathic constipation in children, anal fissure both in children and adults, as well as obstructive symptoms in children with Hirschsprung Disease [5–7]. Botulinum toxin injections are also effective in short-term anismus, defined as a functional disorder of the defecation process that entails relaxation failure or even paradoxical contraction of the puborectalis muscle and contraction of the external anal sphincter during defecation [8]. Zhang et al. evaluated the efficacy of botulinum toxin type A injection to the puborectalis and external sphincter muscle in the treatment of 31 patients in whom previous biofeedback therapy had proved unsatisfactory [9]. Chronic constipation scoring system and anorectal manometry showed that the injection of botulinum toxin, combined with pelvic floor biofeedback training, was effective in 24 of the 31 patients [9].