What is Dyssynergic Constipation?
Dyssynergic constipation is a condition in which there is difficulty in passing the stool due to the problem with the muscles and nerves present on the pelvic floor.(1) In this condition, the nerves and muscles on the pelvic floor are not functioning properly. One-half of the people with chronic constipation are diagnosed with dyssynergic constipation.(2) The condition affects the quality of life negatively and affects the work and social life of people diagnosed with it.
Causes of Dyssynergic Constipation
The exact cause of dyssynergic constipation is not known but 1/3rd of the people with this condition are known to have it since childhood.(3)
The rectum is present at the bottom of the long intestine and is known to store stool and move it out of the body through the anus. The pelvic floor muscles work together to coordinate the stool out of the rectum. The anal canal also has two sphincters known as the external and internal sphincters that help maintain continence.
In dyssynergic constipation, there is impaired coordination between the pelvic floor muscles.(4) Also, improper contraction and relaxation of internal and external sphincters during bowel movements can be a major contribution.
Looking at the above discussion, dyssynergic constipation can have the following causes:
- Impaired pushing
- Impaired awareness to defecate
- Inadequate rectal contractions
- Contraction of puborectalis muscles when there is a need to relax
- Contraction of internal and external sphincters when there is a need to relax
dyssynergic constipation is known to occur since childhood but people with myasthenia gravis and multiple sclerosis are also known to suffer from it. Also, a history of physical and sexual abuse can increase the chances of a person suffering from dyssynergic constipation.
Symptoms of Dyssynergic Constipation
The symptoms of dyssynergic constipation include:
- Hard stool
- Abdominal bloating
- Excessive straining
- Feeling of incomplete evacuation
- Less than 3 bowel movements per week
- Digital evacuation or vaginal splinting(5)
How is Dyssynergic Constipation Diagnosed?
There are several tests that can be helpful in diagnosing dyssynergic constipation. These include:
- MRI scan to detect any organ or tissue damage that might be making the bowel movement hard.
- Blood test is done to rule out other causes of constipation.
- Sigmoidoscopy, in this test a finger or a sigmoidoscope is used to examine the lower part of the colon.
- Anorectal manometry, in which a balloon is inserted into the anus and inflated to stimulate a stool and view how a bowel moves along. Sometimes barium paste may be used. Doctors monitor the response to pressure or with an instrument to watch how easily it is passed.
- Colonic transit time exam is a test in which capsules with special markers are given. Over a period of a few days, an x-ray is ordered to view how easily things are moving through the system.
How is Dyssynergic Constipation Treated?
The following are the treatments that can be helpful for dyssynergic constipation:
Biofeedback is a therapy in which sensors are placed around the body that can be helpful in measuring the reaction to certain stimuli. It can be helpful for people to learn how to overcome dyssynergic constipation.
This treatment is known to be effective in 60% of people with dyssynergic constipation.(6)
The information gained from biofeedback can also be helpful for the therapist to suggest exercise to restore strength and control muscles responsible for the movement of stool through the system.
Eating more grains, vegetables, and legumes in the diet can be helpful for the stool to move through the intestine.
Sometimes fiber supplements are also given.
Sometimes certain medications including nonsteroidal anti-inflammatories and antacids might cause constipation. A person, who observes that the medications are causing constipation, should inform the doctor about the medication and request an alternative.
In some cases, laxatives and stool softeners may be helpful.
There are a few exercises that can be helpful in strengthening and gaining control over the muscle that moves the stool through the intestines.
Anyone passing stool not more or less than three times a week or having to insert the finger to evacuate stool should consult a doctor. Also, if there is blood in the stool a doctor should be informed. Dyssynergic constipation may be really uncomfortable but has safe and pain-free ways to deal with it.