Pyloris Botox

Botox Injection for Anal and Pyloric Sphincters

At Nationwide Children’s Hospital, Botox injection is one of several advanced treatments we may use for children with motility or nerve/sensation problems. Most children are first treated with standard options such as diet changes, medicines and pelvic floor or behavioral therapies. When these are not enough, carefully placed Botox injections can sometimes help by relaxing muscles that are too tight at key “valves” in the digestive tract.

These valves, called sphincters, help control stomach emptying and in the lower part of the digestive tract – stool emptying. When they do not relax as they should, children can develop severe constipation or problems with nausea, vomiting and delayed stomach emptying. Botox injections are used only after careful evaluation by our motility experts.

What is a Botox sphincter injection?

“Botox” is a brand name for botulinum toxin, a medicine that relaxes muscles for a few months at a time. When a small amount is injected directly into a sphincter muscle, it weakens that muscle just enough to let it relax and open more easily. This can help stool pass out of the rectum or help food move from the stomach into the small intestine.
Your child’s doctor may suggest Botox injection only after other treatments have not worked well enough. It may be used for:

• Severe constipation and trouble passing stool because the anal sphincter stays too tight, including some children with Hirschsprung disease, internal anal sphincter achalasia or functional outlet obstruction
• Painful tears in the skin around the anus (anal fissures) that are made worse by a tight anal sphincter
• Gastroparesis or delayed gastric emptying, where the stomach empties too slowly and causes ongoing nausea, vomiting, early fullness and poor weight gain. In these cases, Botox is injected into the pyloric sphincter at the bottom of the stomach.

What do these procedures involve?

Before the procedure, you will meet with the gastroenterology team to review your child’s history and tests. We will explain the procedure, anesthesia and recovery, and answer questions. Your child will need to stop eating and drinking for a period of time before the procedure, as directed by the care team.
Anal sphincter injection: This is usually done in the operating room or procedure suite while your child is asleep under general anesthesia. The doctor gently places a small instrument into the anus and uses a tiny needle to inject Botox into the internal anal sphincter muscle in several spots. No cuts are made on the outside. The procedure is brief, and most children go home the same day.
Pyloric sphincter injection: This is done during an upper endoscopy. While your child is asleep, the doctor passes a thin flexible tube with a camera (endoscope) through the mouth into the stomach. Using the scope, the doctor injects Botox into the pyloric sphincter to help it relax and open more easily, which may improve stomach emptying and reduce nausea and vomiting for some children.

What are the benefits and risks?

Many children have improvement in stooling or vomiting after Botox injections, though the effect is temporary and may last a few months. While many do not need repeat injections, some children need repeat injections or additional treatments.
Side effects are usually mild but can include brief pain at the injection site, temporary stool accidents (leakage) after anal injections, or short-term worsening of nausea or stomach discomfort after pyloric injections. Serious complications are uncommon when the procedure is done by experienced pediatric specialists. Your child’s doctor will review the specific risks and benefits for your child.

Why Nationwide Children’s Hospital?

At Nationwide Children’s, Botox injections for motility problems are offered through our Neurogastroenterology and Motility Disorders Center, a high-volume pediatric motility program that cares for children with some of the most complex constipation and gastric emptying problems. Families come to us because we focus on the whole child — not just a single test or procedure. Your child’s care is led by pediatric GI specialists and supported by pediatric anesthesia, nursing, psychology, nutrition and social work. We use advanced motility testing and child-sized equipment to improve safety and comfort, and we work with your family to decide if Botox is the right option.