Happy Tuesday! Caution: I am ready to delve into a private topic today. I will be talking about constipation, specifically, dyssynergic defecation. This topic might not be your favorite cocktail party chatter …but hey, someone has to do it! So, here I go.
I have talked a bit about pelvic floor dysfunction in the past on my blog but not in detail. I won’t take a major deep dive on this topic but wanted to expand your knowledge a bit. I see many, many patients in my clinical practice that have been diagnosed with a pelvic floor disorder.
I asked Satish Rao, MD, Director of the Digestive Health Center at Georgia Regents University and world-renown motility specialist to provide some details for you, “Pelvic floor disorders encompass many problems that include: dyssynergic defecation, rectal prolapse, excessive perineal descent and fecal incontinence and others. Pelvic floor disorders affect 20% of the population and profoundly affects quality of life, particularly in elderly. Recognizing the problem, defining the underlying mechanism(s) and providing appropriate treatment(s) are cornerstones for successful management. This requires a multidisciplinary approach involving gastroenterologist, registered dietitian, biofeedback therapists and motility labs.”
So, what the heck is dyssynergic defecation? Dyssynergic defecation occurs when the muscles and nerves in the rectum do not work properly or in a coordinated fashion. Symptoms often present as constipation or sense of incomplete emptying. Treatment is pelvic floor physical therapy and/ or biofeedback.
According to IFFGD ( International Foundation for Functional Gut Disorders ) website, a great resource for individuals with functional gut disorders:
“It is not clear what causes 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 exhibit an inability to coordinate these muscles. Most often this problem of coordination consists either of:
- impaired rectal contraction or tightening rather than relaxing (paradoxical contraction) 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, there is a problem with their ability to perceive the arrival of stool in the rectum.
A survey of 100 patients with the dyssynergic defecation 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.”
IFFGD has a good review of dyssynergic defecation here.
How is dyssynergic defecation diagnosed? IFFGD has a good review here. Most practitioners can get the information they need with anorectal manometry testing. This is the test I recommend. A small, flexible sensor is placed in your rectum (about the size of rectal thermometer.) This is connected to a computer and a recording device that measures the pressure and strength of your anal and rectal muscles. The test measures coordination of muscles, reflex action, sensation, strength and weakness of rectal and anal muscles.
Outside of the low FODMAP diet, I have found that physical therapy and biofeedback for dyssynergic defecation are cornerstones of symptom management for many of my patients. I have found in my practice–that patients of all ages, men and women, have had issues with dyssynergic defecation.
Unfortunately, I have also found that many {not all, thankfully!} GI doctors do not order or are somewhat resistant to order testing for this condition. I think many practitioners feel that undergoing the testing, the follow up physical therapy and biofeedback is invasive, time-consuming, and that most patients would not partake in it. Interestingly, in my practice, I find patients are very amenable to do most testing and treatment as they want to be an active participant in getting their life back!
The purpose of this post is to educate you on dyssynergic defecation. To encourage you to discuss testing with your GI doctor if you feel that this condition may be playing a role in your GI symptoms.
I believe this disorder has been a contributor to relapsing SIBO that many of my patients experience as well. If you are not emptying your colon properly and it remains full of stool, this impacts the motility of your small bowel.
I would love your feedback if you feel comfortable sharing your story. I realize it is a personal one. Have you tried physical therapy or biofeedback for dyssnergic defecation? Has it helped?
Joanna
This is super interesting! I just read a book -Move your DNA by Katy Bowman and she talks quite a bit about pelvic floor dysfunction. Her prospective on this is more mechanical and she attributes that to “misalignment” -of the pelvic itself (due to our sedentary lifestyle). The pelvic tilt also contributes to many other physical issues; low back pain, knees, etc. I am not an expert in the area by any means but I found this very intriguing. Great post! thank you!
Shoshana T.
Hi Kate! This post comes at a great time personally because I have been recently diagnosed with Abdomino Phrennic Dyssenergia, a form of PFD but more in the abdomen. Basically since I have been off of SIBO antibiotics 3 months ago exactly (amox clav) I have had terrible lower abdomen distention, to the point i look 7 mos preg by the end of the day and there is a sour type pain that exists with it. Pretty awful! At first i thought it was the antibiotics that wiped by gut clean and that i had to heal from after sibo. Then i thought i had sibo again, but my new test came out negative. And since then this is what my diagnosis is. Im on a GI soft diet and eat smaller meals, but its not much help. Not many physical therapists are familiar with this issue since it is fairly a new thing… There is a great post on it in the TIMES about a gymnast who was treated at mayo clinic with biofeedback. I am also being tested for a few more things (neuro issues, etc) so before I start crazy expensive physical therapy I want to make sure this is the actual diagnosis, since it is actually hard to really diagnose, its more of an assumption at this point. Supposedly visceral biofeedback is the way to go. But i am interested to hear what people say about Biofeedback etc, and wonder if you have heard of this type!! All the best!!
katescarlata
Thanks for sharing Shoshana! I have not heard of that type of dyssynergia. Biofeedback has great support in the scientific literature for dyssynergia.
Whitney Stewart
I am interested in knowing what the testing involves. I was diagnosed with a slow SI motility (unexplained, so far) and recurring SIBO. However, when I am on Rifaxin, my motility and bowel movements feel normal (for the ten days I am on it). My GI has suggested seeing a motility specialist in another state for further testing, because I seem to have done all the testing my city has to offer (have seen 3 GI docs here).
Geoff Faulkner
I used to have this sort of thing happening to me but I found after years of self tesing I discovered that when I ate a lot of cheese It happened. I still eat cheese but only a small handfull once a week
Melissa Riesgo
Hi Kate – Thank you so much for posting this. Very interesting! Your post is so timely – I met with a physical therapist for the first time this week to begin pelvic floor therapy/biofeedback. In just the first appointment I learned SO MUCH about my condition and exercises in order to work on getting these muscles back to a relaxed state. It was eye-opening at how high my pressure is, which explains so much. I’m really interested to see what kind of progress I can make. I would really encourage anyone who is struggling with incomplete emptying to take the anorectal manometry test.
As always, thanks for the helpful information!
-Melissa
Gabriela Gardner
Hello Kate,
I work with an MD that luckily tests for this condition with anorectal manometry. I’m interested in learning what other nutrition recommendations you may have for these patients. I understand how the FODMAP diet might be helpful with SIBO, but are there any other resources, literature, or tips that you wouldn’t mind sharing?
Thank you!!
katescarlata
Hi Gabriela, Happy to share any tips. When your say these patients–are you referring to IBS patient specifically or those with pelvic floor dyssynergia?
Gabriela
I’m referring to patients with pelvic floor dyssynergia.
katescarlata
With pelvic floor dyssynergia–I find patients often benefit from magnesium supplementation. I like the product natural calm natural vitality. Once the colon is cleansed and working better, titrating up some fiber can be helpful. I find chia seeds work well in this population too.