Editorial: Botox for levator ani

Excerpt

There is a significant unmet need for management of pain in functional anorectal pain disorders and we applaud Dr. Ooijevaar and his coauthors for their report on this complex patient population [1]. The authors identified the subgroup of patients with hypertonic pelvic floor who were refractory to medical therapy and treated them with Botox injection therapy. They made an important delineation between patients who complained of anorectal pain and had normal levator examination and those with marked tenderness over the levators and hypertonia on digital rectal exam. The outcome of Botox therapy was good in 47%, temporary in 20%, and poor in 37%. We are impressed by the authors’ report of 47% “good” improvement. Botox targets muscle relaxation, decreases spasticity, and thus alleviates pain secondary to high muscle tone. Although in another noncontrolled study of patients with chronic anorectal pain symptoms improved after botulinum toxin injection in 55.5% of patients [2] the efficacy of Botox injection was not superior to placebo in a prospective double blind placebo-control study [3]. Nonetheless, pelvic floor physical and biofeedback therapy is the only evidence based therapy for chronic anorectal pain syndrome [4] …