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Discussion Starter · #1 ·
About a year ago I visited this sight in search of help for my 68yo Dad, and I want to share the news for anyone it may help. He was having severe constipation and has had maybe 2 bowel movements since March that were not induced by an enema, which he resorted to after the failure of Citacel, metamucil, senna tea, suppositories, stool softeners, laxatives, miralax� the list goes on. With the accompanying bloating, gas, stomach pain and weight loss, the man was miserable with no quality of life. It also affected his bladder function. (note: he was initially trying to lose weight. Lost 50 lbs, stopped trying, lost 20 more. This all started while he was trying to lose weight.) After numerous CT scans, MRI's, blood tests, manometry, biofeedback, unsuccessful defacagrophy(sp), none of the doctors would even venture a diagnosis. In November, I stumbled across an article about Botox being used to relax the sphincter muscle. We were able to get into IU Medical Hospital for a follow-up colonoscopy and the Dr. there was willing to try the Botox. During the colonoscopy it was noted that his colon was enlarged- approx 8 inches in dia. I think he was ingesting sufficient fiber! It took about 10 days(he was scheduling surgery!) and he has now had 9 unassisted bowel movements in 8 days! My Father is laughing again for the first time in a year! I was afraid he was going to have his colon removed...which is all the local Dr.s ever suggested. Another topic I stumbled across in this journey and may be of interest to you is called "Ogilvie's Syndrome". Google it. It is a parasympathetic disorder associated with electrolyte imbalance among other things. My dad was drinking a gallon of water a day and was still dehydrated. Switch to Gatorade!I wish you all the best and hope this can help someone. I know how frustrating this ordeal can be. If you're not getting answers, find another doctor!
 

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Sorry I wasn't clear, He did not have surgery. The dr. told him the botox would take effect in 20 minutes. After the procedure, he at first felt that it was easier to pass gas. That was encouraging, but it was 6 days before he had a BM and that required an enema. (Keep in mind he had been cleaned out for the colonoscopy and that his colon was dilated.) He assumed the Botox was unsuccessful and scheduled an appointment to see the surgeon and arrange to have his colon removed. He said he would rather have a bag than live like this. I was concerned that his colon could burst or leak. I'm sure you know how difficult it is to get a medical professional to explain anything to you!Luckily the appointment was cancelled due to the snowstorm. It was about 11 days after the Botox injection that he began having BM's on his own.The Doctors had repeatedly said they could find no physical reason for his constipation. During the defacagraphy he was unable to evacuate any of the substance they pump into your rectum. He always felt like he had to go but couldn't and seldom had the "urge". The Dr's left him feeling like it was his fault or that it was in his head!The Dr told me that they injected the Botox into the internal (involuntary) sphincter muscle but that some would get into the external muscle also. I'm not sure how accurate that information is. I don't know who is really working with this. I think the trick is finding someone who will try it. In our case I felt that the worst-case scenario was that he could become incontinent, but that that would only last 3-6 months. It was worth a try since everything indicated to me that his rectum wasn't relaxing and that was causing the colon problems. He is also taking 1/2 doses of miralax. When he took Miralax last spring he still couldn't release it. Now he's adjusting the dose to see if he needs to take it at all.other notes: For the last year, he had severe back pain that subsided when he was able to have a Bm. For the most part, he felt like he couldn't "push". I hope this clarifies things. I'll post as I think of things that might be of interest. Let me know if you have any other questions.
 

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fuha,I don't know if you're still around or not, but I'm desperately searching for a doctor willing to use Botox. Could you please tell me the name of the doctor who treated your father? Does anyone else know of a doctor willing to try Botox injections?Thanks,Susan
 

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I had botox done a few weeks ago to treat an anal fissure that didn't respond to nitroglycerine creme. I don't know if he does it for other issues, but he did say he's one of the few (or only) doctor in the Seattle area doing it. My initial response has been good, but I'm constipated again and that's not helping much...My doctor (surgeon) is:Sam Salama1515 116th Ave NESuite 205Bellevue WA 98004425 455-4900
 

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Eric Gu,what is your diagnosis?Did you had a defecography?How long you felt better?
 

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Dis Colon Rectum. 1996 Oct;39(10):1107-11. Links Initial North American experience with botulinum toxin type A for treatment of anismus.Joo JS, Agachan F, Wolff B, Nogueras JJ, Wexner SD. Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309, USA.PURPOSE: Botulinum toxin type A (BTX-A), produced by Clostridium botulinum, is a potent neurotoxin. The purpose of this study was to evaluate the efficacy of BTX-A for treatment of anismus. MATERIALS AND METHODS: All patients treated with BTX-A for anismus were evaluated. Eligibility criteria included a history of chronic assisted evacuation (laxatives, enemas, or suppositories), demonstration of anismus by cinedefecogram and electromyography, and failure of a minimum of three sessions of supervised biofeedback therapy (BF). Contingent on body mass, 6 to 15 units of BTX-A was injected bilaterally under electromyography guidance into the external sphincter or the puborectalis muscle. Treatment was repeated as necessary for a maximum of three sessions during a three-month period. Success was considered as discontinuation of evacuatory assistance and was evaluated between one and three months and again at up to one year. RESULTS: Between July 1994 and May 1995, four patients ranging from 29 to 82 years in age (2 females, 2 males) had anismus that failed to respond to between 3 and 15 biofeedback sessions. All patients improved between one and three months after BTX-A injection, and two had sustained improvement for a range of three months to one year. There was no morbidity or mortality associated with BTX-A injection. CONCLUSIONS: BTX-A is extremely successful for temporary treatment of anismus that is refractory to BF management. However, because the mechanism of action is short, longer term results are only 50 percent successful. Hopefully, modifications in the strain of BTX-A and dose administered will allow longer periods of success or a repeat trial of BF. Nonetheless, this preliminary report is very encouraging in offering a method of managing this recalcitrant condition.http://www.ncbi.nlm.nih.gov/entrez/query.f...t_uids=10733120Botulinum toxin in the treatment of outlet obstruction constipation caused by puborectalis syndrome.Maria G, Brisinda G, Bentivoglio AR, Cassetta E, Albanese A. Department of Surgery, University Hospital Agostino Gemelli, Rome, Italy.PURPOSE: Puborectalis syndrome has been difficult to treat. We investigated the efficacy of botulinum toxin in treating patients with puborectalis syndrome who had previously failed to respond to electromyographic biofeedback sessions and who refused to use anal dilators. METHODS: Of a group of 50 patients with chronic outlet obstruction constipation, four patients with puborectalis syndrome were included in the study. The patients were studied using anorectal manometry, defecography, and electromyography and then treated with 30 units of Type A botulinum toxin, injected into two sites on either side of the puborectalis muscle, under ultrasonographic guidance. RESULTS: One patient was lost to follow-up. After treatment in other patients, the frequency of natural bowel movements increased from zero to six per week and laxatives were needed by only one patient. Anorectal manometry demonstrated decreased tone during straining from (mean +/- standard deviation) 96.2 +/- 12 mmHg to 42.5 +/- 13 mmHg at four weeks (P = 0.003) and 63.2 +/- 22 mmHg at eight weeks (P = 0.009). Defecography performed eight weeks after treatment showed improvement in the anorectal angle, which increased from 94 +/- 11 degrees to 114 +/- 13 degrees (P = 0.01), and evacuation of barium paste. Electromyography demonstrated mild paradoxical contraction. However, 16 weeks after treatment one of these three patients suffered symptomatic recurrence. This patient was re-treated with 50 units of toxin; eight months later he required a further 60 units. Seven months after the last injection he reported normal daily bowel movements without the use of laxatives. CONCLUSIONS: Botulinum toxin injection should be considered as a simple therapeutic approach in patients with puborectalis syndrome. The use of higher dosage and a more precise method of toxin injections under transrectal ultrasonography account for the long-term higher success rate. However, because the effects of the toxin wear off within three months of administration, repeated injections could be necessary to maintain the clinical improvement.
 
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