Dyssynergic Defecation: When Pooping Becomes a Challenge
Introduction
Bowel problems significantly impact people's lives. Pooping is a basic human activity, and when it's not working properly, it can be distressing. Dyssynergic defecation, a condition where the coordination between the pelvic floor muscles and the colon is disrupted, can make pooping a real challenge. Let's dive into what dyssynergic defecation is, its causes, symptoms, and how to treat it.
What Exactly Is Dyssynergic Defecation?
Dyssynergic defecation occurs when the pelvic floor muscles do not coordinate properly with the colon. When the colon contracts to push the poop out, the pelvic floor muscles should relax and open to allow this process. However, in dyssynergic defecation, these muscles contract instead of relaxing, preventing the stool from passing. Many patients are unaware of this incoordination until it is shown to them during medical examinations.
Diagnosis
Dyssynergic defecation is typically diagnosed through an anorectal examination and tests like anorectal manometry or defecography. These tests assess muscle activity and coordination while attempting to expel a balloon or during an MRI scan.
Why Does It Happen?
Dyssynergic defecation is common in people with constipation. Studies suggest that nearly 40% of constipated individuals experience this incoordination. Factors contributing to dyssynergic defecation include:
Childhood constipation: About 30% of adults with dyssynergic defecation had constipation as children.
Frequent straining: Nearly 46% of affected individuals strained frequently to pass hard stools.
Pregnancy: The physical hormonal changes during pregnancy can affect bowel function.
Traumatic injury: Injuries, especially to the pelvic area, can disrupt muscle coordination.
Low back pain: Chronic back pain can influence the pelvic floor muscles.
History of sexual abuse/trauma: Psychological and physical impacts can affect bowel habits.
Poor behavioral habits: Inconsistent bowel routines and poor dietary habits contribute to this condition.
Unknown reasons: Sometimes, the cause remains unidentified.
What Are The Signs And Symptoms?
Dyssynergic defecation is common among those struggling with constipation. Typical symptoms include:
Excessive straining: Difficulty pushing out stool.
Feeling of incomplete evacuation: A sensation that the bowel movement is not fully complete.
Abdominal bloating: Swelling and discomfort in the abdomen.
Frequent hard stools: Passing hard, dry stools regularly.
Digital maneuvers: Using fingers to assist in stool removal, either by pulling it out or pressing inside the vagina.
What Can You Do About It?
The good news is that dyssynergic defecation can be effectively treated with conservative methods. Pelvic physical therapists, in collaboration with GI and colorectal physicians, are typically the best providers for this condition. Treatment usually involves several components:
1. Develop Better Bowel Habits
Good bowel habits are the foundation of treating dyssynergic defecation. This includes:
Diet: Ensure a high-fiber diet with plenty of fluids.
Routine: Establish a regular bowel routine because our bowels coordinate with our circadian rhythm and pattern.
Toilet position: Use an optimal toilet position, like the one recommended by Squatty Potty.
2. Biofeedback Training
One type of biofeedback training can use electrodes to monitor the anal sphincter and abdominal muscles. However biofeedback can also be provided with certified pelvic floor therapists which can help identify your current pattern of muscle use and improve coordination with proper training. Research supports biofeedback as an effective treatment for dyssynergic defecation.
3. Strengthen and Relax Pelvic Floor Muscles
Pelvic floor muscles need to be strong, flexible, and well-coordinated. Treatment focuses on:
Awareness: Learning to identify and control pelvic floor muscles.
Relaxation: Techniques to relax and lengthen these muscles.
Manual therapy: Internal vaginal or rectal therapy to reduce muscle tightness and improve mobility.
Colon massage: A type of abdominal massage to help stimulate your gastrocolic reflex for emptying. (Pictured below)
4. Balloon Retraining
Balloon retraining involves inserting a small balloon into the rectum, which is then inflated. This helps improve rectal sensitivity and proper expelling techniques. Though it may sound unusual, it is highly effective and supported by research.
Top 10 Tips for Managing Dyssynergic Defecation
Stay Hydrated: Drink plenty of water daily to soften stool.
Eat Fiber-Rich Foods: Incorporate whole grains, fruits, and vegetables into your diet.
Exercise Regularly: Physical activity helps keep your digestive system moving.
Avoid Holding It: Go to the bathroom as soon as you feel the urge.
Find Your Perfect Position: Experiment with different toilet positions to find what works best for you. We highly recommend the squatty potty to help.
Take Your Time: Don’t rush your bowel movements; allow your body to work naturally.
Relax: Stress can affect bowel movements, so practice relaxation techniques.
Consider a Footstool: Elevate your knees above your hips for easier pooping.
Listen to Your Body: Pay attention to your body’s signals and don’t ignore the urge to go.
Seek Help if Needed: If you experience persistent issues, consult a healthcare professional, specifically a certified pelvic floor therapist.
FAQ Section
Q: What is dyssynergic defecation?
A: Dyssynergic defecation is a condition where the pelvic floor muscles do not coordinate properly with the colon, leading to difficulty in passing stool.
Q: How is dyssynergic defecation diagnosed?
A: It is typically diagnosed through an anorectal examination and tests like anorectal manometry or defecography.
Q: What are the common symptoms of dyssynergic defecation?
A: Common symptoms include excessive straining, feeling of incomplete evacuation, abdominal bloating, frequent hard stools, and the need for digital maneuvers to assist in stool removal.
Q: Can dyssynergic defecation be treated?
A: Yes, it can be effectively treated with methods like developing good bowel habits, biofeedback training, strengthening and relaxing pelvic floor muscles, and balloon retraining.
Conclusion
Dyssynergic defecation can be a challenging condition, but with the right approach, it is manageable. By developing good bowel habits, training with a certified pelvic floor therapist, and learning to strengthen and relax the pelvic floor muscles, you can improve your bowel movements and overall quality of life. If you experience persistent issues, seek professional advice from a GI or colorectal physician and consult with a pelvic physical therapist.
By following these tips and incorporating healthy habits, you can ensure better bowel health and avoid common problems associated with dyssynergic defecation. For more personalized advice, consult with a pelvic floor physical therapist.
Written by:
Dr. Jana Richardson, PT, DPT, WCS, PRPC, CIDN
Dual Board Certified Pelvic Floor Therapist and Owner of Chicago Pelvic Health
Dr. Jana Richardson is a highly accomplished pelvic floor therapist with dual board certifications and extensive experience in treating complex pelvic floor dysfunctions. As the owner of Chicago Pelvic Health, Dr. Richardson is dedicated to providing personalized and effective care for her patients. With a Doctorate in Physical Therapy, and specialized certifications in Women’s Health and Pelvic Rehabilitation, Dr. Richardson is a leading expert in her field. She is also certified in Integrative Dry Needling, further enhancing her ability to offer comprehensive treatment plans. Dr. Richardson’s commitment to patient-centered care and her passion for helping individuals achieve optimal pelvic health make her an invaluable asset to the community.