ABSTRACTBackground and objectives Chronic constipation stays one of the most common and challenging problems facing the doctors and the family as well. Most of these cases are idiopathic. A lot of medical and surgical treatment modalities are in use; however there is no universal way to manage resistant cases. Each method had its own benefits and side effects.Recently Botox were used in the management of idiopathic constipation in children. The aim of this study is to evaluate the role of Botox injection in the management of these cases.Methods A prospective study of 25 children with idiopathic constipation underwent Botox injection in two pediatric surgery centers. The children condition was assessed before and after the injection using the same scoring system. The material was injected in the internal sphincter.Results Patient's age ranged from 2 to 9 years. Twenty four percent of the patients had significant (p value < 0.05) and sustained improvement at three and six months after injection. While (36%) had significant improvement at three months, but they relapsed at 6 months after injection. Other 40% had no significant improvement (p value > 0.05). No patient had deterioration of his score at the time of therapy. Transient fecal incontinence was noticed in three patients and all recovered within two weeks. No complications wererecorded through out the study.Conclusions The use of Botox in managing idiopathic constipation in children is a new and safe method with good response but the problem is the significant relapse rate and should be reserved for selected resistant cases.