Aim: to compare the results of partial division of puborectalis (PDPR) versus local botulinium toxin (BTX-A) injection in 
treating patients with anismus. 
Methods: this prospective randomized study included 30 male patients with a mean age 38.93 ± 12.39 years and a mean duration of 5.80 ± 3.96 years. Diagnosis was made by clinical examination, barium enema, colonoscopy, colonic transit time, anorectal manometry, balloon expulsion test, defecography, and EMG. Patients were randomized into: Group (I): included 15 patients injected with BTX-A, and Group (II): included 15 patients who underwent bilateral PDPR. Follow up was conducted for one year. 
Results: Both BTX-A and PDPR significantly reduced the preoperative constipation scores. The initial and long term success rates were 86.7% and 40% in BTX-A group versus 100% and 66.6% in PDPR group. Recurrence was observed in 7 patients (53.8%) and 5 patients (33.4%) following BTX-A and PDPR respectively. Minor incontinence had occurred in 2 patients (13.3%) following PDPR. 
Conclusion: BTX-A injection seems to be successful for temporary treatment of anismus. However, PDPR has been found to be a promising method for treatment of anismus with a relatively lower morbidity in relation to its higher success rate.