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).


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