A team from Rome and Pesaro, Italy, investigated the efficacy of botulinum toxin in treating patients with symptomatic rectocele.
14 female patients with anterior rectocele were included in the study.
The patients were studied by using anorectal manometry and defecography. They were then treated with a total of 30 units of type A botulinum toxin, injected into 3 sites, 2 on either side of the puborectalis muscle and the third anteriorly in the external anal sphincter, under ultrasonographic guidance.
After 2 months, symptomatic improvement was noted in 9 patients. At the same time, rectocele depth was reduced from a mean of 4.3 cm to 1.8 cm, and rectocele area from 9.2 cm2 to 2.8 cm2.
Anorectal manometry demonstrated decreased tone during straining from 70 mm Hg at baseline to 41 mm Hg at 1 month and to 41 mm Hg at 2 months.
The researchers observed no permanent complications in any patient for a mean follow-up period of 18 months.
At 1-year evaluation, no patient reported incomplete or digitally-assisted rectal voiding. In addition, a rectocele was not found at physical examination.
|Mean rectocele depth and area:|
4.3cm and 9.2 cm2
1.8cm and 2.8 cm2
4 recurrent, asymptomatic rectoceles were noted at defecography.
Researcher Giorgio Maria, of the University Hospital Agostino Gemelli, Rome, said on behalf of fellow authors, "Botulinum toxin injections should be considered as a simple therapeutic approach in patients with anterior rectocele. The treatment is safe and less expensive than surgical repair.
"A more precise method of toxin injections under transrectal ultrasonography accounts for the high success rate."
"Repeated injections may be necessary to maintain the clinical improvement," it was concluded.