Dyssynergic Defecation: A Comprehensive Review on Diagnosis and Management

Abstract

About one-third of chronically constipated patients have an evacuation disorder, and dyssynergic defecation is a common cause of the pelvic evacuation disorder. In dyssynergic defecation, the coordination between abdominal and pelvic floor muscles during defecation is disrupted and patients cannot produce a normal bowel movement. The etiology of dyssynergic defecation is still unknown. Although a detailed history taking and a careful examination including digital rectal examination could be useful, other modalities such as anorectal manometry, balloon expulsion test and magnetic resonance or conventional defecography are necessary for the diagnosis. Biofeedback therapy is one of the most effective and safe treatments. Here, we provide an overview of dyssynergic defecation as well as how to diagnose and manage this condition.

Health-Related Quality of Life and Psychosocial Variables in Women with Colorectal Pelvic Floor Dysfunction: A Cross-Sectional Study

“…The prevalence of chronic functional constipation has been estimated to affect 10% to 15% of the population, depending on the Rome criteria applied for its diagnosis, and it has also been shown to be higher in women than men [ 11 ]. Data concerning dyssynergic defecation are less accurate; it is usually accepted that between 27% and 50% of cases of chronic constipation are due to dyssynergia [ 12 , 13 ]. Similarly to fecal incontinence, it is more frequent in women and in older people [ 12 , 13 ].…”

“…Data concerning dyssynergic defecation are less accurate; it is usually accepted that between 27% and 50% of cases of chronic constipation are due to dyssynergia [ 12 , 13 ]. Similarly to fecal incontinence, it is more frequent in women and in older people [ 12 , 13 ]. Chronic pelvic pain is estimated to affect up to 24% of women worldwide, and its most frequent colorectal etiology is levator syndrome [ 14 ].…”

Biorretroalimentación con electroestimulación para el tratamiento de la disinergia defecatoria

“…Su etiología es desconocida, pero se atribuye a un trastorno conductual adquirido de la defecación, sin base orgánica ni neurológica; sin embargo, existe una interacción de varios mecanismos en su patogenia, como secundarios a embarazo, partos traumáticos, mal aprendizaje de la defecación desde la infancia, propulsión rectoabdominal débil, etc. 3 .…”

A Rapid Review on the Management of Constipation for Hospice and Palliative Care Patients

“…8 Rome IV criteria expanded the definition to include 4 subtypes of constipation: (1) functional constipation, (2) irritable bowel syndrome with constipation, (3) opioid-induced constipation (OIC), and (4) functional defecation disorders, including inadequate defecatory propulsion and dyssynergia defecation (insufficiently coordinated contractions of the anorectal muscles). [9][10][11] Treating constipation in palliative care patients poses challenges. When the regular bowel pattern changes, a cascade of events can occur that impact functional status and often result in deleterious outcomes.…”

“…Rome III criteria, published in 2006, outlined patient-reported symptoms for diagnosing chronic or functional constipation 8 . Rome IV criteria expanded the definition to include 4 subtypes of constipation: (1) functional constipation, (2) irritable bowel syndrome with constipation, (3) opioid-induced constipation (OIC), and (4) functional defecation disorders, including inadequate defecatory propulsion and dyssynergia defecation (insufficiently coordinated contractions of the anorectal muscles) 9-11 …”