SEVERE CONSTIPATION IN PARKINSONS-DISEASE RELIEVED BY BOTULINUM TOXIN

A parkinsonian patient with severe outlet-type constipation was treate d with injection of botulinum toxin into the puborectalis muscle. A to tal of 30 units (Botox) was injected in two sites. Resting anal pressu re, maximum voluntary contraction, and pressure on straining were eval uated before treatment and 4, 8, 12, and 16 weeks afterward. Pressure values declined following treatment, the decline of pressure an strain ing ending by week 12. Proctography performed 8 weeks after treatment showed improvement in the anorectal angle and evacuation of barium pas te. The clinical benefit lasted for similar to 12 weeks. The present d ata show that botulinum toxin is a promising tool for treating outlet- type constipation in Parkinson's disease.