Purpose
Previous study of sphincter dysfunction treated by botulinum toxin typus A (BTA) injection into anal wall utilized procedures such as EMG, sedation and/or ultrasound control. We introduce a new, easy method for application of BTA to anal sphincters through the diffusion of BTA from injection site.
Methods
Patients with anal pain caused by defecation and patients with pain during sphincters extension near the posterior midline in proximal part of anus after non effective ointment treatment were qualified for BTA treatment. During per rectal exam, patients were asked to pinpoint the most painful area during sphincter extension. BTA injection was administered in the identified area by anoscope (125 U of Dysport/ml). The results of the treatment were monitored using an anus manometer, a balloon expulsion test and a subjective scale of pain.
Results
Patients (n=13) were injected with BTA. Prior to the injection, five subjects had positive balloon expulsion test results. When anal pain disappeared, the balloon was easily voided. Manometrically (after BTA injection) changes were only observed in maximal voluntary contraction. None of the subjects reported complaints, even after the fifth month of observation.
Conclusion
Exact subject and per rectum examination enable accurate injection of BTA for treatment of insufficient relaxation of anal sphincters during defecation.

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