Objective:

To evaluate the effectiveness and safety of surgical interventions for managing anismus.

Approach:

• Conservative Measures: Pelvic floor rehabilitation biofeedback and Botulinum toxin injection have been used to manage anismus.
• Surgical Techniques: Division of the puborectalis muscle is aimed at relieving tension for effective defecation.
• Modified Bilateral Partial Miotomy: A minimally invasive approach was reported with no cases of bleeding, sepsis, rectal injury, or anal incontinence.

Key Findings:

• Anismus affects 44% of constipated patients with obstructed defecation.
• Bilateral partial miotomy showed a 70% cure rate for anismus at 1 year.
• No permanent anal incontinence was reported in patients undergoing bilateral partial miotomy.

Interpretation:

The procedure is considered safe with low postoperative morbidity, but its effectiveness varies and requires careful patient selection.

Limitations:

• Literature consists of fewer than 300 patients over two decades.
• No studies reported follow-up periods longer than one year.

Conclusion:

Bilateral partial division of the puborectalis for anismus can be safe, but careful patient selection is crucial to avoid complications.