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Constipation & Dysynergic Defecation
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woman in bed suffering from Dysynergic Defecation

Pelvic Floor Dysynergia, Dysynergic Defecation, and Chronic Constipation

Can pelvic floor therapy help with the various forms of constipation?

It's National IBS Month! We are continuing our bowel health series to help you achieve optimal pelvic health. Having bowel movements is something everyone must do, and sometimes it is difficult to have a bowel movement. While the causes for constipation can vary, today we want to talk about a particular dysfunction that pelvic floor therapy can greatly help with: dysynergic defecation.

What is dysynergic defecation and how common is it?

Dysynergic Defecation is a muscle coordination issue where you think you are relaxing your anal sphincter to defecate, but in reality you are actually contracting your muscles and closing off the sphincter. In short, your pelvic floor muscles are doing the opposite of what your brain is telling them to do. Dysynergic defecation is common; an estimated 40% of patients with chronic constipation also have dysynergic defecation, according to this study.

But wouldn’t you be able to tell if you have it?

Dysynergic defecation, like other coordination issues, are hard to detect on your own. This is because your brain thinks that the muscles are doing the right action, when they are actually doing the opposite of what you want them to do. In this case, the pelvic floor muscles are firing incorrectly and it is often tied to poor coordination of the abdominal muscles, and sometimes decreased sensation of the rectum.

Dysynergic defecation is diagnosed typically by an anorectal examination, and anorectal manometry/defecography testing (like this, with an MRI), or by assessing muscle activity with EMG while the person attempts to expel a balloon, or other testing options)

What are the signs and symptoms?

The most common symptom of dysynergic defecation is constipation.

Constipation symptoms:

  • 3 bowel movements or fewer per week
  • Abdominal discomfort and pain
  • Abdominal bloating
  • Straining to have a bowel movement (holding your breath, pushing out the gut)
  • Sense of incomplete evacuation when you are done on the toilet
  • Bowel movements that are hard. Often pebbles, pebbles pushed together, or a log with lots of cracks.
  • Needing to use fingers to pull out stool or to push on surrounding tissues to evacuate

What happens when it goes untreated?

Constant straining and pushing bowel movements out of the body while holding your breath increases intra-abdominal pressure. This pressure can start forcing organs to move, usually down south, eventually creating or worsening a pelvic organ prolapse. That is if left untreated, constant straining with bowel movements will cause you to start pushing your organs. In some cases of prolapse, organs such as the bladder, uterus, vaginal wall, or rectal wall will begin to push on the pelvic floor, sometimes bulging or protruding. Constant strain will also cause the muscles of the pelvic floor to spasm or become weak.

How can pelvic floor therapy help?

A licensed pelvic floor therapist can conduct a thorough evaluation of the pelvic floor and help you come up with strategies to have a bowel movement without straining.

Examination may include an internal exam via the vagina or rectum, observing the movement of the pelvic floor muscles, as well as palpation of the structures of the belly and pelvic area.

The ultimate goal of our treatment plans at Femina Physical Therapy is to help you fully relax the pelvic floor and to be able to have a complete bowel movement without strain or pain. This might include manual therapy to treat tight and guarding pelvic floor muscles that may be preventing healthy bowel movements. Other treatments will help with neuromuscular retraining, helping your brain and muscles coordinate correctly so that you are actually relaxing your muscles when you think you are relaxing them. Your therapist will also work with you to create healthy bowel habits, problem solve positioning on the toilet, the time you are spending on the toilet, and other habits that can help create regularity.

 

Resources

1. Rao, S. S. C., & Patcharatrakul, T. (2016). Diagnosis and Treatment of Dysynergic Defecation. Journal of Neurogastroenterology and Motility, 22(3), 423–435. https://doi.org/10.5056/jnm16060

2. Rao SSC. Biofeedback Therapy for Constipation in Adults. Best practice & research Clinical gastroenterology. 2011;25(1):159-166. doi:10.1016/j.bpg.2011.01.004.

What Our Patients Have to Say

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Testimonial by Fritzette H.

I went to Heather after the birth of my third child. It was lucky, really, that I was referred to her, because my doctor had referred me to a surgeon for a possible hysterectomy or pelvic wall rebuild. Thankfully, I went to Heather before undergoing either surgery, she was able to fix the problem. She has studied extensively in women's health--even written a book about it--and was able to diagnose my problem, suggest a course of treatment (6 weeks), and then follow through with said treatment. By the end, as she said, I was as good as gold. Boy, was it worth it! Though uncomfortable to talk about, much less write about, it is worth getting the word out there. If you have painful intercourse, especially after birth or other trauma, the treatment may be as simple as Physical Therapy (with Heather, of course). I highly recommend her.

-- Fritzette H., 3/24/16 via Yelp!

Testimonial by R.M., Age 40

I can’t speak highly enough of the theapists at Femina Physical Therapy and how much they have helped me grow, discover, and love my body. I had had painful sex for my entire life, and didn’t know that there was anything that could be done about it. It was at the point where my husband and I were not having sex for MONTHs, because it was just too frustrating, and I hated feeling like I was the ONLY woman out there who had this problem, especially at my age. I finally brought it up to my doctor because I was turning 40 and my husband and I were barely having enough sex to conceive. And she brought up pelvic floor, PT. I didn’t even know this was a “thing”.

Read more: Testimonial by R.M., Age 40

Testimonial by Rosanna R., age 35

Heather has affected my life in the MOST POSITIVE way and I am forever grateful. My husband refers to her as the "sex doctor" so you can only imagine how happy he is with my therapy outcome.

After the birth of my son I suffered from "Vaginismus", however, at the time I just thought I was broken. My "broken vagina" affected me physically but it was an emotional struggle as well. Many women in my life also suffered with pain from sex after their babies were born so I knew I wasn't alone. They told me they "just got used to it" but I couldn't see myself living that way.

Sex wasn't just painful, it was literally impossible - IT DIDNT FIT!

Read more: Testimonial by Rosanna R.,...

Testimonial by Rosanna R., age 35

Heather has affected my life in the MOST POSITIVE way and I am forever grateful. My husband refers to her as the "sex doctor" so you can only imagine how happy he is with my therapy outcome.

After the birth of my son I suffered from "Vaginismus", however, at the time I just thought I was broken. My "broken vagina" affected me physically but it was an emotional struggle as well. Many women in my life also suffered with pain from sex after their babies were born so I knew I wasn't alone. They told me they "just got used to it" but I couldn't see myself living that way.

Sex wasn't just painful, it was literally impossible - IT DIDNT FIT!

Read more: Testimonial by Rosanna R.,...

Testimonial by A.W., age 32

I wanted to let you know that my pelvic floor held strong and gave me no trouble whatsoever in my trail race this morning (12 miles)! In a way, I felt like I ran better than ever because my core feels so rock solid from all the exercises you have me doing. That was especially valuable on the technical downhill - I just flew down the trail because I had confidence in my balance and form. Thank you for helping me get back to doing what I love.

-- A.W., age 32
(completed Post-partum Renewal Program using the InTone biofeedback/stim unit)

Testimonial by Julie T.

Femina PT (née Fusion Wellness & Physical Therapy) has honestly changed my life. Before receiving treatment at Femina, I was going doctor to doctor to try and find the answer to my pelvic pain. It has taken me YEARS to find someone that can help fix this. It wasn't until my gynecologist recommended your clinic that I finally felt relief. My pelvic pain is almost gone, and granted I still have a lot more to work on with Laureen (my PT), my original problem is nearly cured. I am so grateful to her.

What is even better is she gave me practical exercises to do at home that were not tedious and provided instant (and lasting) relief. Although I mainly work with Laureen, my interaction with the owner (Heather) has been great. She is very generous, kind, and committed to her business.

It hurts to know there are women out there suffering who will never know or have the opportunity to work with women like Laureen and Heather because this issue is hardly talked about and this field is so rare. I hope more doctors and physical therapists see the value in this work and can relieve more woman of their pain.

-- Julie T., 12/4/16 via Yelp!

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