title: Botulin toxin in the treatment of nonrelaxing puborectalis syndrome.
abstract: OBJECTIVE
  To evaluate the results of botulin toxin injection in the external anal sphincter for the treatment of nonrelaxing puborectalis syndrome.
  
  
  METHODS
  15 patients (13 women, 2 men; aged 36-48 years) were treated with botulinum A toxin injection, using a dose of 25 IU diluted in 1 ml normal saline injected into the top loop of the external anal sphincter at the 3 and 9 o'clock positions. The mean follow-up period was 14.6 +/- 3.3 (SD) months.
  
  
  RESULTS
  Two patients did not respond to the treatment while improvement occurred in 13. Straining at defecation disappeared and stool frequency was normalized. Improvement was maintained for a mean of 4. 8 +/- 1.4 SD months, after which time reinjection needed to be done. No adverse side effects were encountered.
  
  
  CONCLUSIONS
  Botulin toxin injection is a simple, easy and safe method for the treatment of nonrelaxing puborectalis syndrome. It is to be considered after biofeedback has failed.
authors.affiliation: Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: A
authors.initials: A
authors.lastname: Shafik
authors.forename: O
authors.initials: O
authors.lastname: El-Sibai
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000187:drug effects* / Q000503:physiopathology; D001905:Botulinum Toxins / Q000008:administration & dosage*; D003248:Constipation / Q000188:drug therapy / Q000209:etiology; D003672:Defecation / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000188:drug therapy* / Q000209:etiology; D013577:Syndrome
chemical_list: D001905:Botulinum Toxins