Chronic Constipation and 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.