DYSSYNERGIC DEFECATIONDr. Nitin Borse
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).