{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:11:25Z","timestamp":1792084285273,"version":"4.4.0"},"reference-count":36,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2012,1,10]],"date-time":"2012-01-10T00:00:00Z","timestamp":1326153600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2012,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:bold>Aim\u2002<\/jats:bold> Anismus causes obstructed defecation as a result of inappropriate contraction of the puborectalis\/external sphincter. Proctographic failure to empty after 30\u2003s is used as a simple surrogate for simultaneous electromyography\/proctography. Botulinum toxin is theoretically attractive but efficacy is variable. We aimed to evaluate the efficacy of botulinum toxin to treat obstructed defecation caused by anismus.<\/jats:p><jats:p><jats:bold>Method\u2002<\/jats:bold> Botulinum toxin was administered, under local anaesthetic, into the puborectalis\/external sphincter of patients with proctographic anismus. Responders (resolution followed by recurrence of obstructed defecation over a 1\u2010 to 2\u2010month period) underwent repeat injection. Nonresponders underwent rectal examination under anaesthetic (EUA). EUA\u2010diagnosed rectal prolapse was graded using the Oxford Prolapse Grade 1\u20135.<\/jats:p><jats:p><jats:bold>Results\u2002<\/jats:bold> Fifty\u2010six patients were treated with botulinum toxin. Twenty\u2010two (39%) responded initially and 21\/22 (95%) underwent repeat treatment. At a median follow up of 19.2 (range, 7.0\u201330.4)\u2003months, 20\/21 (95%) had a sustained response and required no further treatment. Isolated obstructed defecation symptoms (OR\u2003=\u20037.8, <jats:italic>P<\/jats:italic>\u2003=\u20030.008), but not proctographic or physiological factors, predicted response on logistic regression analysis. In 33 (97%) of 34 nonresponders, significant abnormalities were demonstrated at EUA: 31 (94%) had a grade 3\u20135 rectal prolapse, one had internal anal sphincter myopathy and one had a fissure. Exclusion of these alternative diagnoses revised the initial response rate to 96%.<\/jats:p><jats:p><jats:bold>Conclusion\u2002<\/jats:bold> Simple proctographic criteria overdiagnose anismus and underdiagnose rectal prolapse. This explains the published variable response to botulinum toxin. Failure to respond should prompt EUA seeking undiagnosed rectal prolapse. A response to an initial dose of botulinum toxin might be considered a more reliable diagnosis of anismus than proctography.<\/jats:p>","DOI":"10.1111\/j.1463-1318.2011.02561.x","type":"journal-article","created":{"date-parts":[[2011,1,19]],"date-time":"2011-01-19T17:55:17Z","timestamp":1295459717000},"page":"224-230","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Excellent response rate of anismus to botulinum toxin if rectal prolapse misdiagnosed as anismus (\u2018pseudoanismus\u2019) is excluded"],"prefix":"10.1111","volume":"14","author":[{"given":"R.","family":"Hompes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Harmston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Wijffels","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O. 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