Pelvic floor dyssynergia: symptoms, causes and treatment

Pelvic floor dyssynergia (or defecatory dyssynergia) is a pathology that responds to an alteration in muscular coordination, in this case, a lack of synchronization between abdominal contractions and anal sphincter function.

This disease accounts for approximately half of the cases of chronic constipation, and therefore, knowing its causes and treatments is essential for anyone who presents irregularities when going to the bathroom. Here we show you everything you need to know about her.

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Pelvic floor dyssynergia: a functional disorder

To understand the origin and treatment of pelvic floor dyssynergia, it is necessary to discuss chronic constipation and its clinical manifestations beforehand.

About constipation and its figures

According to various medical portals, constipation is defined as a process based on scanty defecation, three times a week or less, difficulty emptying the bowel, hard and bulky stools or feeling of intestinal impaction.

These signs may also be accompanied by gas, bloating, and stomach cramps. In Spain, chronic functional constipation disorders can affect from 14 to 30% of the population, depending on the demographic sector in which we look.

Even so, it is essential to clarify that there are four different types of chronic constipation:

• Constipation with normal transit: the most common, since it represents 60% of the cases.
• Slow transit constipation, which represents 13% of cases.
• Defecation disorders, such as hemorrhoids or anal fissures, present in 25% of cases.
• A combination of the last two types, with a very low incidence of 3% of cases.

In addition to the classification set forth above, the types of constipation can be classified as anatomical (due to structural alterations of the organism) or functional (anisms, that is, due to motor incoordination).

All this terminology and percentages help us to classify the dyssynergia of the pelvic floor, since it is a pathology of chronic functional constipation of the pelvic floor, the which affects 10 to almost 20% of the general population. It is a non-organic acquired behavioral defect, that is, it is not found at birth and does not respond to an anatomical abnormality. Like many other pathologies, it could be said that this one comes “from the head”.

Causes

Pelvic floor dyssynergia is widely correlated with common factors in the life of any adult, such as stress and anxiety.

In addition, there are other intrinsic factors of the person himself that can promote the appearance of chronic constipation, such as gender (women are more prone to it) or ethnicity. Other parameters such as inadequate nutrition, lack of exercise, aging, a low socioeconomic level or depression favor intestinal disorders.

Anxiety and stress are also linked to many other gastrointestinal processes, as they have been shown to generate an imbalance in the normal intestinal microbiota (commensal bacteria), thus favoring the appearance of gas, colic and other clinical manifestations. These emotional disorders, so commonplace in a busy society, also manifest themselves in other forms, such as increased heart rate, rapid breathing, tremors, and sweating excessive.

For all these clinical manifestations (including defecation dyssynergia), as well as for the negative effect that has on the one who suffers them, seeking psychological help in the face of generalized stress and anxiety becomes essential.

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Symptoms

Pelvic floor dyssynergia is characterized by symptoms shared with many other intestinal disorders. This is, the sensation of incomplete evacuation and repeated defecation efforts over time among many other discomforts, already named previously.

Diagnosis

The diagnosis of this pathology is very specific, because to find it, it is necessary to first rule out dysfunctions of anatomical, metabolic origin (such as diabetes) or constipation derived from the application of drugs or consumption of drugs. To do this, a series of specific steps are followed that we show you below.

1. Physical exploration

First of all, it is necessary to carry out a rectal examination and examination, since thus, pathologies of structural origin are ruled out. In addition, this touch is highly sensitive for diagnosing pelvic floor dyssynergia, as it also allows the pressure of the anal musculature to be assessed both at rest and on exertion.

It may also be necessary to ask the patient to keep a "defecation diary", noting during 15 to 30 days various parameters when going to the bathroom (use of laxatives, effort evacuation...etc.)

2. Balloon expulsion test

As strange as it may seem, this diagnostic method is based on the rectal introduction of a probe with an inflated balloon at its end into the patient. This must strain to defecate such as would occur during a normal bowel movement, and, in general, if it takes more than a minute to expel it, it may be a sign of dyssynergia. This test has shown a usefulness for stellar detection, since it allows to clearly support the diagnosis in up to 97% of the cases.

3. Anorectal manometry

This technique consists of measuring pressures inside the anus and rectum, both at rest and during continence or defecation. It's based on the placement of a probe, about 10 centimeters deep rectal, which allows the measurement of various parameters, such as:

• Tone and symmetry of the rectal smooth muscle.
• Same values ​​for striated muscle.
• Rectoanal reflexes.
• Rectal tenderness.
• rectal compliance.
• defecation maneuver

4. defecography

This last detection method, in this non-invasive case, is based on the use of specialized machinery in magnetic resonance, which provides images of the different defecation stages of the individual. This allows to assess how well the pelvic muscles are working and to provide information about rectal function.

All these diagnostic tests, as we have seen, are intended to rule out physiological structural abnormalities and to test the motility of the patient's rectal musculature.

Treatment

Biofeedback is the treatment of choice for pelvic floor dyssynergia, and is based on performing a series of 30-minute outpatient sessions for one or two weeks.

Through the use of manometry probes and other methods, it is sought that the patient gains awareness of his own rectal musculature, which promotes greater self-control over their sphincter muscle function and coordination motorboat. The effectiveness of this technique is up to 80% of cases.

Other accompanying factors that may promote the disappearance of this rectal muscle abnormality may be exercise as a routine, a diet rich in fiber and fluids and the use of laxatives early after diagnosis. It goes without saying that psychologically and routinely tackling anxiety and stress disorders, should they occur, will also be essential to address the pathology.

Summary

As we have seen, defecatory dyssynergia is a pathology that does not respond to physiological or anatomical disorders, such as anal fissures, hemorrhoids, etc. It is a disease widely linked to the emotional and mental health of the patientWell, as we have said before, it is linked to situations of anxiety, stress and depression.

The diagnostic methods that lead to the detection of this disease are varied and complex, because in the first place, we must rule out any other disease linked to metabolic processes or physical.

Bibliographic references:

• Aisa, A. P., Chaves, A. I., Lanagrán, M. L., Fernandez, M. L. M., & Rodríguez, P. J. R. (2019). Session III.: Predictive factors of defecation biofeedback response in defecation dyssynergia. Andalusian Journal of Digestive Pathology, 42(5), 210-218.
• Bechiarelli, A. A., Ramos-Clemente, M. T., Guerrero, P. P., & Ramos, C. R. (2016). Constipation. Medicine-Accredited Continuing Medical Education Program, 12(7), 337-345.
• Colmenares, G. V., Jimenez, M. M., Perez, S. R., Cendón, R. G., Salgueiro, J. V., & Alonso, M. L. (2017). Home anorectal training as a treatment for encopresis and sphincter dyssynergia. Cir Pediatr, 30, 28-32.
• Garrido, a. S., Bermejo, A. P., Pomo, Y. J., & Soler, A. m. (2012). Constipation. Medicine-Accredited Continuing Medical Education Program, 11(6), 331-336.
• Lanagran, M. L., Ordonez, M. R., & Aisa, Á. Q. (2013). Diagnostic therapeutic approach in defecatory dyssynergia. Andalusian Journal of Digestive Pathology, 36(4), 231-236.
• Romero, m. T. R. C., Gomez, A. R. C., Almanzor, A. V., & de la Cruz, M. S. (2018). defecatory dyssynergia. Andalusian Journal of Digestive Pathology, 41(2), 78-83.
• Wainstein, C., Carrillo, K., Zarate, A. J., Fuentes, B., Venegas, M., Quera, R.,... & López-Köstner, F. (2014). Results of pelviperineal rehabilitation in patients with pelvic floor dyssynergia. Spanish Surgery, 92(2), 95-99.