Researchers are testing rectal Botox injections to see if they could help patients manage fecal incontinence—so far, the results are promising. If future studies confirm success, doctors could provide patients with new ways to manage this difficult condition.[]
In a randomized, double-blind, placebo-controlled study, researchers treated nearly 200 patients for fecal incontinence using Botox or a placebo. Ninety-six patients received Botox and 95 received the placebo treatment after nine patients withdrew from the trial before receiving the injections.[]
The Botox group received a submucosal injection of 200 injection units of botulinum toxin type A (BoNTA), while the placebo group received the same volume of saline. Data were collected blindly for six months, after which participants were unmasked and members of the placebo group were offered the Botox treatment, with an additional six months of safety monitoring. The study was conducted in France between November 25, 2015 and November 25, 2020.[]
The results showed that Botox injections appeared to be effective in reducing people’s fecal incontinence and urgency. Now, researchers say the treatment could hold promise as a first-line drug for urge incontinence.[]
Botox has been used as a treatment for urge incontinence for years, with “good results and few side effects,” adding to researchers’ confidence in the success of the treatment for fecal incontinence. Other types of rectal injections, such as Solesta injections, are also used for fecal incontinence.[]
Bryan Curtin, MD, MHSc, a board-certified gastroenterologist and Director of the Center for Neurogastroenterology and Gastrointestinal Motility at The Melissa L. Posner Institute for Digestive Health and Liver Disease at Mercy Medical Center in Baltimore, MD, says he routinely uses Solesta injections to help patients with fecal incontinence. In his experience, this yields positive results.
Solesta is a bulking dextranomer gel, which Dr. Curtin says he injects into the subcutaneous tissue of the patient’s distal rectum receiving the treatment. When giving an injection, he says, it’s important to assess the condition of the patient’s anal sphincter, which can provide information about why they’re experiencing incontinence—and help predict whether treatment will be successful.
“I always perform a rectal manometry and sigmoidoscopy before injections to rule out structural disease and confirm that there are weakened anal sphincters,” explains Dr. Curtin. “This intervention is not as successful if the reason for the incontinence is more due to dyssynergistic defecation.”
Dr. Curtin adds that he estimates that 80% or more of his patients get about a year’s relief from one treatment.
“I have several patients who come back to me for injections every year,” says Dr. Curtin. “Faecal incontinence is a very difficult problem to completely solve, but in my experience, injections can reduce the frequency and severity of accidents and reduce the need for anti-diarrheal drugs such as Imodium.”
Dr. Curtin has never personally treated a patient who experienced serious side effects after treatment.
In the Botox injection study, the most commonly reported non-serious side effect was constipation, which, depending on how you interpret it, could mean the treatment is working very Good.
Louise Hateleyphysiotherapist and Director of In Stride Health Clinic in Australia, says she is optimistic about the future of faecal incontinence treatments.
“Quality of life can be greatly affected by fecal incontinence, so it’s critical to move forward with treatment options,” says Hateley. “While pelvic floor exercises and pilates are important standard physiotherapy approaches to treating discomfort, rectal injections may be a new option for people suffering from this condition, which is often difficult to treat with traditional techniques ».
Hateley stresses the need for more studies on the safety and efficacy of the treatment in order to best care for patients in need.
The researchers say more studies are needed to optimize the treatment’s delivery, including determining specific injection sites on the body and recommended doses. Future studies must also continue to assess risks, assess long-term treatment efficacy, and identify the best candidates.
Depending on how future studies turn out, you may be able to offer patients this treatment instead of or alongside existing options.
What does this mean for you?
Researchers are testing rectal Botox injections for fecal incontinence. The results are promising, but more studies are needed to confirm safety and effectiveness. If and when that happens, you may be able to provide this treatment to patients.
