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Dyssynergic Defecation: About a Common Cause of Chronic Constipation

Introduction

Constipation is defined as the experience one of more problems with bowel movements (BMs) such as

  • infrequent bowel movements,
  • hard and difficult to pass bowel movements,
  • incomplete bowel movements,
  • straining to have a bowel movement,
  • prolonged duration of time needed to evacuate a bowel movement,
    use of digital maneuvers (use of fingers) to assist bowel movement.
  • A number of factors can cause constipation that is persistent or long-lasting (chronic constipation).

Among the most common is a condition called dyssynergic defecation. About 40% of chronic constipation is caused by this condition.

What is Dyssynergic Defecation?

Dyssynergic Defecation

Dyssynergic defecation is an acquired condition in which there is a problem coordinating the abdominal, rectal and anal muscles (Pelvic Floor) to achieve a normal and complete bowel movement.

The pelvic floor is a group of muscles located at the lower part of the abdomen, between the hip bones, that supports pelvic organs such as the rectum, uterus, and urinary bladder. One of its most important functions is to help make possible our ability to have orderly bowel movements.

Working together, the pelvic floor nerves and muscles help maintain the ability to control movements of the bowels and bladder (also known as continence) until we have a bowel movement. Failure of this to happen can lead to problems of constipation

When do People Develop Dyssynergic Defecation?

A survey of 100 patients with the condition found that in nearly one-third (31%) the problem began in childhood. About an equal number (29%) appeared to have developed the problem after a particular event, such as pregnancy or an injury. In the remaining 4 out of 10 persons (40%), no cause was identified that may have brought on the condition in adulthood.

It may be that too much straining to expel hard stools over time is a factor that may lead to dyssynergic defecation.

Why do People Develop Dyssynergic Defecation?

Muscles in the abdomen, rectum, anus, and pelvic floor must all work together in order to facilitate defecation.

Most patients with dyssynergic defecation show an inability to coordinate these muscles. Most often this problem of coordination consists either of impaired abdominal or rectal muscle contraction together with tightening rather than relaxing of the anal muscles during defecation, or not enough relaxation of the anal muscles. This lack of coordination (dyssynergia) of the muscles that are involved in defecation is primarily responsible for this condition.

In addition, at least one-half (50-60%) of patients with dyssynergic defecation also show evidence of a decrease in sensation in the rectum. In other words, their ability to perceive the arrival of a bowel movement in the rectum is abnormal. This condition is also known as rectal hyposensitivity.

What are the Symptoms of Dyssynergic Defecation?

People with dyssynergic defecation have a variety of bowel symptoms. As with many conditions involving the bowel, individuals may hesitate to speak plainly about these symptoms. Some may feel embarrassed to even mention bowel or stool-related matters. Others may simply not know how to describe their symptom experiences, or know what to discuss.

It is important for individuals to keep in mind that anything out of the ordinary, rather than being a source of embarrassment, is often the very reason for the visit to their doctor.

It is necessary to speak plainly to the healthcare provider so they can most effectively diagnose and treat the problem. It is not unusual, for example, for a person with long-term constipation to find it necessary to use their finger to move stool out of the anus (providers call this disimpacting stool with digital maneuvers).

Another common example is for women to use their fingers to press on their vagina to move stool (providers call this vaginal splinting). In other words, these are medical signs that are meaningful to a healthcare provider.

Patients and doctors both benefit from establishing a relationship of comfort and trust. Open communication is essential. It may be easier to write down the troublesome signs and symptoms before the doctor visit. The use of a symptom questionnaire or stool diary is a helpful way to communicate and identify the exact nature of a bowel problem.

A number of studies have found that the following are common symptoms or signs associated with dyssynergic defecation, with 2 out of 3 or more of individuals reporting:

  • Excessive straining
  • A feeling of incomplete evacuation
  • The passage of hard bowel movements
  • A stool frequency of less than 3 bowel movements per week
  • The use of digital maneuvers (fingers) to help have a bowel movement.
  • Prolonged duration of sitting on the toilet.
  • Making multiple visits a day to have a bowel movement.

Backache, heartburn, and anorectal surgery have been noted as more likely in patients with pelvic floor dysfunction. However, symptoms alone are usually not enough to predict dyssynergic defecation.

Learn More about Dyssynergic Defecation

Adapted from “Dyssenergic Defecation: Questions and Answers About a Common Cause of Chronic Constipation”– An IFFGD Publication #237 by Satish S.C. Rao, MD, PhD, FRCP(LON), AGAF, Chief, Section of Gastroenterology/Hepatology and Director, Digestive Health Center, Medical College of Georgia, Georgia Regents University, Augusta, GA.

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IFFGD is a nonprofit education and research organization. Our mission is to inform, assist, and support people affected by gastrointestinal disorders.

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