الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Background: Pediatric chronic constipation is a challenging pediatric problem with bad impact on quality of life affecting both the child and family; it is a complex disorder of multifactorial etiology and pathophysiology. The diagnosis of functional defecation disorders is primarily based on history and physical examination. Many symptoms-based systems have been instructed for clarified definitions such as ROME and PACCT criteria. The protocol of management of functional constipation usually includes; disimpaction enemas, feeding regulations, bowel diaries and laxatives.
Objective: To evaluate the effectiveness of adding anal Botox injection to those already followed management plan for pediatric age group suffering from chronic functional constipation.
Patients and Methods: The current study included 40 children (3-12 years) with functional constipation, and obstructed defecation. The study included 45% female members and 55% male ones.
Results: Bowel management program was applied on both groups A and B, with Botulinum toxin injection for group B patients only. Improvement was achieved in 22.5% of children in both groups after 2 months of the management, most of the improved cases were in group B, 15%of all cases in ratio of 2:1 in comparison to group A that formed 7.5%.
Conclusion: At the 6 months follow up, the improvement percentage remained at 7.5% in group A and became 17.5% in group B. It is important to note that at the beginning of the study no subject had a good or excellent Rintala score when evaluated and at the end of the study 10% had good scores and 15% had excellent scores. The good scores were achieved equally by both groups, but group B had higher representation in the excellent scores (5 patients from group and a single patient from group A).