D Patel et al. J Pediatr Gastroenterol Nutr. 2025;80:956–962. Efficacy of anal botulinum toxin injection in children with functional constipation

Methods: This was a retrospective, multicenter study including pediatric patients (n=63) who received anal botulinum toxin (BTX) for functional constipation (FC) refractory to medical therapy.  Response to therapy was assessed based on improvement in weekly frequency of BM (bowel movements) to 3 or more per week and/or resolution of functional incontinence (FI)

Key findings:

• There was a a response rate of 10% in group 1 (FC +FI), 50% in group 2 (only FC) and 14% in group 3 (only FI); the an overall symptom resolution in 21% of patients
• Fecal incontinence was the most common side effect, reported in 11% of all patients 

My take: In this highly-selected refractory population, there was a poor response to BTX in those with fecal incontinence (groups 1 and 3). The results should be interpreted with caution due to the retrospective nature of the study and the a lack of a control group.

Related blog posts:

• Position Paper: Pediatric Refractory Constipation Management (2025). “There is no clear role of anal botox in the treatment of patients with RC without a diagnosis of IAS achalasia”
• NASPGHAN Postgraduate Course 2017 (Part 5): Refractory constipation, Extraesophageal GERD, POTS, Recurrent Abdominal Pain
• Refractory Constipation -Terrific Update (2015)
• ANMS Virtual Symposia on Constipation
• Pictographic Constipation Action Plan
• New Data on Bisacodyl for Pediatric Constipation
• Safety of Senna-Based Laxatives
• Constipation Action Plan: Better Instructions, Fewer Phone Calls
• Does It Make Sense to Look for Celiac Disease in Children with Functional Constipation?
• You Can Do Anorectal Manometry in Your Sleep, But Should You?
• More than Two Years of Constipation Before Specialty Help
• Is There a Residual Impact of a Tethered Cord on Colonic Motility
• AGA Constipation Guidelines
• Radiographs and Constipation -Bad Practice and Good Study
• Quality Improvement: Fewer Xrays for Constipation
• Long Term Use of Polyethylene Glycol (PEG 3350)
• Is It a ‘Waste’ to Do Colonic Manometry in Kids with Autism?

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