O1043: Utilization of Botulinum Toxin After Implementation of a Bowel Management Program in Hirschsprung Disease

Background: Botulinum toxin is effective in treating obstructive symptoms secondary to nonrelaxing internal anal sphincter in Hirschsprung disease. Routine use of botulinum toxin in young patients can be a useful adjunct until children learn how to overcome nonrelaxing sphincters, typically after the age of four to five years. Formal bowel management programs can increase odds of successful stool evacuation. Patients participate in a week-long titration of enemas or laxatives, with daily evaluation by the care team. While such programs can be time-consuming, previous studies have demonstrated their effectiveness in achieving social continence. We looked to assess how implementation of a bowel management program can impact rates of botulinum toxin utilization in these patients.

Methods: A retrospective review of patients with Hirschsprung disease from January 2020 through January 2025 at a tertiary colorectal center. Formalized bowel management, through routine laxative or enema initiation and increased monthly offerings of bowel management program. was initiated in June 2023. We assessed rates of botulinum toxin utilization prior to and after initiation of the program.

Results: Eighty-eight (88) patients were analyzed. Demographics are shown in Table 1. We saw a statistically significant decrease in per annual botulinum toxin utilization in patients after implementation of formalized bowel management by 67%. 69 (78.4%) patients were aged less than 5 years at their most recent encounter.

Conclusion: Utilization of a formalized bowel management program can significantly reduce rates of botulinum toxin utilization for patients with Hirschsprung Disease. Management of constipation through formal bowel management can help prevent overuse of botulinum toxin for obstructive symptoms, even in young children.