A new study published in the Journal of Pediatric Surgery investigated the safety of Botulinum Toxin (BT) injection, including response duration, symptom association, and effectiveness, with respect to sphincter dynamics in children with chronic constipation. This was a retrospective study of 164 children who were administered sphincter BT injection for severe constipation, unresponsive to medication management. Patients were grouped as having either a normal sphincter pressure (≤50 mmHg), elevated sphincter pressure (>50 mmHg), with normal recto-anal inhibitory reflex (RAIR) or with an abnormal RAIR. Overall 124 children completed anorectal manometry (ARM). The results showed that 98 patients had positive response while 57% responses lasted more than six months. Of the 36 patients who had a normal sphincter pressure, 24 responded positively. Whereas, 88 patients had elevated sphincter pressure, of which 60 patients had positive responses. Meanwhile, 90 children had normal RAIRs of which 64 had positive responses; 34 had abnormal RAIRs of which 22 showed positive responses. Fecal incontinence prior to BT was a predictor of poor response. The most common side effect was fecal incontinence which typically resolved within a week with equal frequency, regardless of sphincter dynamics. It was concluded that BT is effective in children with chronic constipation, but those with fecal incontinence are less likely to respond. The results showed that more than half of the patients evaluated exhibited prolonged beneficial response. Those with normal and abnormal sphincter dynamics had similar responses and without differences in side effects. Hence, BT injection may be considered in patients with intractable constipation unresponsive to medication, regardless of their anal sphincter dynamics.