A male patient with soiling improved by diazepam

A 62-year-old male patient has suffered from soiling for 9 months. Slight haemorroids were initially treated by medicine and the frequency of soiling decreased. However, soiling persisted about twice per day thereafter. Anorectal manometric study revealed a decrease of maximum resting pressure and squeeze pressure, but anal canal length, anorectal reflex and anal canal rhythmic wave were normal. Conservative therapy with stool bulking agent did not improve the soiling. The defecation state was recorded by the patient, and the result suggested a relationship between the frequency of soiling and the psychological factor. Sulpirid was initially used but did not improved the symptom. Valproate sodium, which had been reported to be useful to improve anal canal resting pressure, did not improve the soiling either. Diazepam was finally administered to the patient, and the soiling disappeared completely. The mechanism of the action is undetermined. However, direct stimulation to γ-aminobutyric acid (GABA) receptor of internal sphincter muscle and/or muscle relaxing action may be a mechanism of the action.