Anismus - Causes, Symptoms & Treatment

Risk Factors

Risk factors for Anismus include:

• History of psychological trauma or anxiety disorders
• Prior pelvic or anorectal surgery
• Chronic constipation with prolonged straining habits
• Female gender
• History of pelvic floor dysfunction

Who is at Risk?

Anismus can affect any age or gender but is more common in women. It is frequently associated with psychological factors and may be seen in patients with a history of trauma, chronic stress, or functional gastrointestinal disorders.

Diagnosis

Diagnosis of Anismus involves:

• Anorectal manometry — measures sphincter pressure during straining
• Defecography — imaging during attempted defecation
• Electromyography (EMG) of the puborectalis
• Balloon expulsion test
• Dynamic MRI of pelvic floor
• Psychological assessment if indicated

Treatment for Anismus

Anismus is primarily treated with biofeedback therapy, which retrains pelvic floor muscles to relax during defecation. Botulinum toxin injections are used in cases not responding to biofeedback. Surgery is rarely required and reserved for refractory cases.

Botox Injection for Anismus

Botulinum toxin injection for Anismus:

• Patient positioned for anorectal access under anaesthesia
• Botulinum toxin injected into puborectalis or external anal sphincter
• Toxin temporarily relaxes the paradoxically contracting muscle
• Effect lasts 3-6 months and injections may be repeated
• Procedure takes less than 30 minutes
• Outpatient procedure with quick recovery
• Often combined with biofeedback for best outcomes

After Treatment

Post-treatment care for Anismus:

• Continued biofeedback therapy sessions
• High-fibre diet and adequate hydration
• Scheduled toilet time with relaxed posture
• Avoid straining or breath-holding during defecation
• Psychological counselling if stress is a contributing factor
• Follow-up manometry to assess response to treatment

Complications | Anismus Treatment

Complications of Anismus treatment include:

• Temporary faecal incontinence following Botox injection
• Incomplete response to biofeedback in some patients
• Recurrence requiring repeat Botox injections
• Psychological distress if treatment response is slow
• Rare allergic reaction to botulinum toxin