WHAT IS CONSTIPATION?
Constipation is one of the most common gastrointestinal complaints in the worldwide population, and more so in females and the elderly. It is not a complaint, but a symptom of various diseases/disorders of mixed etiologies and mechanisms.
Constipation is described as the phenomenon of 2 or more of the following symptoms in the past 12 months (without the use of medicines):
- Less than 3 bowel movements per week,
- Extreme straining during at least 25 % of bowel movements,
- A feeling of incomplete evacuation after at least 25 % of bowel movements, and
- A journey of hard or pellet‐like stool during at least 25 % of bowel movements.
Primary constipation consists of several overlapping subtypes, among which Dyssynergic Defecation (DD) is almost common. Patients withdyssynergic defecation have symptoms of obstructive defecation, such as
- Exacting straining during defecation,
- A sensation of a “blockage”,
- Digital manipulation during defecation and
- A feeling of incomplete evacuation.
The physiological mechanisms of DD include the inability to coordinate abdominal, rectoanal, and pelvic floor muscles during defecation because of causes such as:
- Inadequate rectal and/or abdominal propulsive force,
- Impaired anal relaxation or
- Increased anal outlet resistance as a result of the paradoxical external anal sphincter or puborectalis contraction (muscles in the pelvis).