Could Dyssynergic Defecation Be the Cause of Your Chronic Constipation?

Chronic constipation is a very common health problem. Many people believe constipation is caused only by a lack of fiber, drinking too little water or a lazy bowel. However, scientific studies show that in a significant share of people with chronic constipation, the problem lies not in the bowel but in the coordination of the pelvic floor muscles.

In medicine, this condition is called dyssynergic defecation or defecation disorder due to pelvic floor dysfunction. In dyssynergic defecation, coordination between the abdominal muscles, the rectum and the pelvic floor muscles breaks down during a bowel movement, and the person cannot empty the stool fully.

What Is Dyssynergic Defecation?

Dyssynergic defecation is a functional defecation disorder characterized by the pelvic floor muscles and anal sphincter failing to relax enough, or paradoxically contracting, during a bowel movement.

During a normal bowel movement, three basic mechanisms work together:

1. An increase in intra-abdominal pressure
2. Relaxation of the pelvic floor muscles
3. Opening of the anal canal

In dyssynergic defecation, coordination between these mechanisms is lost. As a result, even when the person strains, stool cannot easily be emptied from the rectum.

This condition can often be one of the main causes of constipation that lasts for years.

What Are the Symptoms of Dyssynergic Defecation?

Dyssynergic defecation usually occurs together with chronic constipation and can show up with the following symptoms:

• Spending a long time on the toilet
• Needing to strain a lot
• Difficulty passing stool
• A feeling of incomplete emptying
• Feeling that there is still stool left after using the toilet
• Hard or lumpy stools
• Using a finger to help with bowel movements

Chronic constipation is usually diagnosed when symptoms such as difficult bowel movements, infrequent bowel movements or a feeling of incomplete emptying persist for a long time.

What Causes Dyssynergic Defecation?

Dyssynergic defecation is not always caused by a single factor. Possible causes described in the literature include:

Incorrectly learned toileting behavior

A habit of holding in stool or chronic constipation in childhood can lead to incorrect use of the pelvic floor muscles.

Coordination disorder of the pelvic floor muscles

When muscles that should relax during a bowel movement contract instead, it becomes harder for stool to pass.

Long-term constipation

Constant straining can change how the pelvic floor muscles function over time.

The nervous system and the gut–brain connection

Bowel function is regulated by the central nervous system, and stress can affect this system.

How Is Dyssynergic Defecation Diagnosed?

A thorough history is especially important for diagnosing this condition. Various tests can also be used for the diagnosis:

• Detailed patient history and a bowel diary
• Anorectal manometry
• Balloon expulsion test
• Pelvic floor EMG assessment
• Colonic transit time measurements

These tests make it possible to objectively assess how the pelvic floor muscles work during a bowel movement.

How Is Dyssynergic Defecation Treated?

According to the scientific literature, the most effective treatment for dyssynergic defecation is pelvic floor biofeedback training and rehabilitation.

Randomized controlled trials have shown that biofeedback therapy significantly improves bowel function in patients with chronic constipation and pelvic floor dyssynergia.

Many studies have reported clinical improvement in 70–80% of patients after treatment.

Treatment usually includes the following approaches:

• Relaxation training for the pelvic floor muscles
• Muscle coordination training with biofeedback
• Correct defecation techniques
• Breathing and abdominal pressure training

These approaches aim to teach the pelvic floor muscles to work with the right coordination again.

When Do You Need a Specialist Assessment?

A pelvic floor assessment is recommended in the following situations:

• Constipation that has lasted a long time
• Excessive straining on the toilet
• A feeling that the bowels never empty completely
• Constipation that continues despite medication
• Needing to go to the toilet again and again throughout the day

These symptoms may suggest that chronic constipation could be due to dyssynergic defecation.

Conclusion

If you are looking for reliable, science-based information about chronic constipation, pelvic floor dysfunction and dyssynergic defecation, you can find detailed articles on this topic at www.tugceatalay.com/ilgi-alanlari/kabizlik.

References

1. Skardoon, G. R., Khera, A. J., Emmanuel, A. V., & Burgell, R. E. (2017). dyssynergic defaecation and biofeedback therapy in the pathophysiology and management of functional constipation. Alimentary pharmacology & therapeutics, 46(4), 410-423.

2. Moore, D., & Young, C. J. (2020). A systematic review and meta-analysis of biofeedback therapy for dyssynergic defaecation in adults. Techniques in coloproctology, 24(9), 909-918.

3. Pucciani, F., Reggioli, M., & Ringressi, M. N. (2012). Obstructed defaecation: what is the role of rehabilitation?. Colorectal Disease, 14(4), 474-479.

4. Heitmann, P. T., Vollebregt, P. F., Knowles, C. H., Lunniss, P. J., Dinning, P. G., & Scott, S. M. (2021). Understanding the physiology of human defaecation and disorders of continence and evacuation. Nature reviews Gastroenterology & hepatology, 18(11), 751-769.