About half of the patients seeking treatment for chronic constipation are found to have dyssynergic defecation when diagnosed by specialists. This condition often has a negative impact on the quality of life, affecting the work and social lives of those diagnosed with the disorder.
Symptoms
The symptoms of dyssynergic defecation parallel those of chronic constipation.
Abdominal bloating Excessive straining Feeling of incomplete evacuation Hard stools Less than three bowel movements per week Digital evacuation (using fingers to assist in a bowel movement)
Causes
It helps to better understand the problem of dyssynergic defecation if you can visualize what the lower end of your digestive system looks like. Your rectum lies at the bottom of your long intestine. The rectum stores stool and is the passageway for stool to make its way out through your anal canal, where it ultimately exits through your anus.
Muscles within the pelvic floor, including those of your abdomen, rectum, and anus, must all work together for the coordinated passage of stool. The muscles of your anal canal include the levator ani muscles and the puborectalis muscle. The anal canal also has two sphincters, an internal sphincter, and an external sphincter, which helps you maintain continence.
In dyssynergic defecation, it appears that the coordination between the muscles that make up the pelvic floor is impaired. In attempting to understand what is going wrong in dyssynergic defecation, specific attention is given to the puborectalis muscle and the internal and external sphincters of the anus. Improper contraction and/or relaxation of these muscles during bowel movements appear to be major contributors to the problem.
To complicate things further, there is some evidence that some individuals who suffer from dyssynergic defecation have an impairment in their perception of stool within the rectum. This may lead to missing cues about the need to initiate a bowel movement, thus exacerbating the constipation problem.
To sum it up, dyssynergic defecation is the result of the following problems:
Impaired awareness of the need to defecateImpaired pushingRectal contraction is inadequateContraction of the puborectalis muscle when it should be relaxingContraction of the internal and external sphincters when they should be relaxingA combination of any of the above factors
In many cases, no specific factor can be identified as causing dyssynergic defecation. For some people, the problem begins in childhood. Other causes have been noted:
ChildbirthPregnancyRectal injuryRepeated passage of hard stoolSexual abuse
Diagnosis
Speak to your healthcare provider if you suspect that your constipation problem may be the result of dyssynergic defecation. Your healthcare provider may recommend some diagnostic procedures and then will work with you to devise a treatment plan.
Alternate Names
The condition of dyssynergic defecation has been called by a wide variety of names over the years, including:
Anal sphincter dyssynergiaAnismusObstructive defecationParadoxical puborectal contractionPelvic floor dyssynergiaPelvic outlet obstructionSpastic pelvic floor syndrome
