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Botox for Defecation Disorders: Are There Complications?

Nov 05, 2020
Little girl

You may have thought botulinum toxin (better known by brand names like Botox®, Dysport®, and Xeomin®) was just for getting rid of wrinkles. However, for many kids with disorders that affect a child’s ability to pass stool, known as defecation disorders, botulinum toxin injections improve symptoms.

The anal sphincter is the circular, muscular structure at the end of the rectum that controls the release of stool. The injection works by relaxing the sphincter muscles, making it easier for children to pass stool.

Botulinum toxin injections in the anal sphincter have become a more widespread treatment option in the last 15 years for the treatment of conditions that make it difficult to pass stool, including:

  • Severe functional constipation – Severe functional constipation is a condition that makes it difficult for a child to pass stool and/or causes them to not pass stool very often.
  • Hirschsprung disease – Children are born with Hirschsprung disease, where certain cells called ganglions are missing from the colon. This causes blockages in the large intestine, making it difficult for a child to pass stool. It often requires surgical removal of a portion of the intestine so they can pass stool more normally.
  • Sphincter achalasia – This condition is similar to Hirschsprung disease, except the ganglion cells aren’t missing. In children with sphincter achalasia, however, a child’s anal sphincter has a hard time relaxing, making it hard for them to pass stool.

Even though it has been used for a while, it wasn’t until recently that this treatment option was studied to determine whether complications outweigh the benefits. Spoiler alert – they don’t!

A collaborative study by doctors and researchers in the Center for Colorectal and Pelvic Reconstruction (CCPR) and the Gastrointestinal Motility Center at Nationwide Children’s Hospital found that complications of botulinum toxin injections for defecation disorders are rare and temporary.

The study looked at nearly 900 children who received botulinum toxin injections from 2014 to 2018 (332 from Nationwide Children’s and 549 from other hospitals). Altogether, complications were reported in just 1% of those studied.

Complications from botulinum toxin injections can include the following:

  • Incontinence – Incontinence is the inability to control bladder or bowel movements.
  • Perianal abscess – This is a sore at the injection site.

Of the nine complications reported, researchers looked for trends based on the child’s age, gender, diagnosis and weight, but they were unable to find any. This shows that side effects to the treatment appear to be random. Additionally, all of the complications reported went away on their own within two weeks of the injection.

Botulinum toxin is a short-term treatment, which explains why any complications tend to also be temporary. Generally, the benefits last three to four months, but in some cases, the injection can help with symptoms of defecation disorders for longer or shorter periods of time.  

So, what does this mean? It means that botulinum toxin isn’t just a common treatment option for kids with defecation disorders; it’s also a safe treatment option.

To learn more about our Center for Colorectal and Pelvic Reconstruction, click here. We are leading the way in research on colorectal conditions and developing new, safe and longer-lasting treatment options.  

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Featured Expert

Richard Wood
Richard Wood, MD
Center for Colorectal and Pelvic Reconstruction

Dr. Wood completed fellowship training in Cape Town, South Africa. In 2014, he joined the CCPR team at Nationwide Children's Hospital. Many of his surgical cases are for complex problems, such as cloacal malformations, vaginal replacement, and reoperations for ARM and hirschsprung disease.

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700 Children’s® features the most current pediatric health care information and research from our pediatric experts – physicians and specialists who have seen it all. Many of them are parents and bring a special understanding to what our patients and families experience. If you have a child – or care for a child – 700 Children’s was created especially for you.