{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T16:17:22Z","timestamp":1787588242780,"version":"build-2736575974"},"reference-count":38,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T00:00:00Z","timestamp":1739750400000},"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":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To elucidate the effect of internal anal sphincter (IAS) botox as an adjunct to standard treatment for disordered defecation (DD), defined by the inability to effectively evacuate stool from the rectum resulting in constipation, on patient\/caregiver quality of life (QoL) metrics in association with corresponding clinical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Consecutive children undergoing IAS botox for DD completed surveys at baseline, two weeks, and three months post\u2010procedure. Time points included assessment of clinical symptoms (Rome IV Questionnaire), QoL (Pediatric Quality of Life Inventory [PedsQL]), and caregiver well\u2010being\/family functioning (PedsQL\u2010Family Impact Module [PedsQL\u2010FIM]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 60 participants, the median age was 7\u2009years (IQR 4\u201310), with 34 (56.7%) males and 32 (53.3%) first\u2010time Botox recipients. The median onset of positive effect after Botox was 6\u2009days (IQR 3\u201314), while the median loss of effect was 70\u2009days (IQR 39\u201383). Compared to baseline, by 3\u2009months there was a lower chance of meeting Rome IV criteria for functional constipation in first\u2010time recipients (RR 0.73, 95% CI: 0.58\u20130.91; <jats:italic>p<\/jats:italic>\u2009=\u20090.005). This remained significant after adjusting for any bowel regimen change during the 3\u2010month period following Botox (OR 0.33, 95% CI: 0.13\u20130.74; <jats:italic>p<\/jats:italic>\u2009=\u20090.012). Regarding QoL, there was significant improvement in total PedsQL score at both 2\u2010weeks (11.79 point improvement, 95% CI: 6.36\u201317.22; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001) and 3\u2009months (13.97 point improvement, 95% CI: 8.47\u201319.47; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001) from baseline for first\u2010time recipients, while improvement was only observed at 2\u2009weeks for prior recipients (6.67 point improvement, 95% CI: 0.65\u201312.69; <jats:italic>p<\/jats:italic>\u2009=\u20090.030). First\u2010time recipients demonstrated significant improvements in total PedsQL\u2010FIM score at both 2\u2009weeks (9.33 point improvement, 95% CI: 3.77\u201314.89; <jats:italic>p<\/jats:italic>\u2009=\u20090.001) and 3\u2009months (11.57 point improvement, 95% CI: 5.94\u201317.20; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001) from baseline.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our findings establish far\u2010reaching benefits of IAS botox primarily for first\u2010time recipients, both clinically and psychosocially, suggesting that appropriate incorporation into the treatment paradigm may globally enhance outcomes in children with DD.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.70005","type":"journal-article","created":{"date-parts":[[2025,2,18]],"date-time":"2025-02-18T06:04:06Z","timestamp":1739858646000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Botulinum Toxin Improves Quality of Life and Clinical Outcomes in Pediatric Defecation Disorders"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5615-8253","authenticated-orcid":false,"given":"Trevor A.","family":"Davis","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Department of Pediatrics Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashlyn","family":"Turner","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Pediatrics Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carrie","family":"Wilson","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Department of Surgery Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinli","family":"Wang","sequence":"additional","affiliation":[{"name":"Center for Biostatistics and Data Science Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon","family":"Joerger","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Pediatrics Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth C.","family":"Utterson","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Pediatrics Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baddr A.","family":"Shakhsheer","sequence":"additional","affiliation":[{"name":"Department of Surgery, Section of Pediatric Surgery University of Chicago  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,17]]},"reference":[{"key":"e_1_2_11_2_1","first-page":"106","volume-title":"Pediatric Gastrointestinal and Liver Disease","author":"Vriesman M. 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