Pelvic floor dyssynergia: symptoms, causes and treatment

These are the characteristics of pelvic floor dyssynergia, a disorder with psychological causes.

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 the pelvic floor and the pelvic floor.In this case, a lack of synchronization between abdominal contractions and anal sphincter function.

This disease accounts for about 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 it.

Pelvic floor dyssynergia: a functional disorder

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

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 in emptying the bowel, hard and lumpy stools, and a lack of bowel movements.hard and bulky stools or a sensation 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 we look at.

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

• Constipation with normal transit: the most common, representing 60% of cases.
• Constipation of slow transit, which represents 13% of the 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 above classification, the types of constipation can be classified as anatomical (due to structural alterations of the organism) or functional (anismic, i.e., due to anatomical alterations of the organism). (anisms, i.e. due to motor incoordinations).

All this terminology and percentages help us to classify pelvic floor dyssynergia more quickly, as it is a pathology of chronic functional constipation of the pelvic floor, which affects 10 to almost 20 % of the general population.. It is a non-organic acquired behavioral defect, i.e. 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. common factors in the life of any adult, such as stress and anxiety..

In addition, there are other factors intrinsic to the individual that may promote the occurrence of chronic constipation, such as gender (women are more prone to it) or ethnicity. Other parameters such as inadequate diet, lack of exercise, aging, low socioeconomic status or depression favor bowel 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 (commensalist bacteria), thus favoring the appearance of gas, colic and other clinical manifestations.. These emotional disturbances, so common in a busy society, also manifest themselves in other ways, such as increased heart rate, rapid breathing, tremors and excessive sweating.

Because of all these clinical manifestations (including defecatory dyssynergia), as well as the negative emotional effect it has on the sufferer, seeking psychological help for generalized stress and anxiety is essential.

Symptoms

Pelvic floor dyssynergia is characterized by symptoms shared with many other intestinal disorders. These are, the sensation of incomplete evacuation and repeated defecatory straining over time among many other discomforts, already mentioned above.already mentioned above.

Diagnosis

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

1. Physical examination

First of all, it is necessary to perform a rectal inspection and rectal examination, because This will rule out pathologies of structural origin.. In addition, this examination is highly sensitive for diagnosing pelvic floor dyssynergia, as it also makes it possible to assess the pressure of the anal musculature both at rest and on exertion.

It may also be necessary to ask the patient to keep a "defecatory diary", recording various parameters during 15 to 30 days when going to the toilet (use of laxatives, evacuatory effort, etc.).

2. Balloon expulsion test

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 make defecatory efforts such as those that would occur during a normal bowel movement, and, in general, if it takes more than a minute to expel it, it may take more than one minute.In general, if it takes more than one minute to expel it, it may be a sign of dyssynergia. This test has demonstrated a stellar detection utility, as it provides clear diagnostic support in up to 97% of cases.

3. Anorectal Manometry

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

• Tone and symmetry of the smooth rectal muscle.
• Same values for the striated muscle.
• Rectal reflexes.
• Rectal sensitivity.
• Rectal distensibility.
• Defecatory maneuver.

4. Defecography

This last detection method, in this case non-invasive, is based on the use of specialized magnetic resonance the use of specialized magnetic resonance machinery, which provides images of the different defecatory stages of the individual.. This makes it possible to evaluate how well the pelvic muscles are functioning and to provide information on rectal function.

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

Treatment

Biofeedback is the treatment of choice for pelvic floor dyssynergia.It is based on a series of 30-minute outpatient sessions over one to two weeks.

Through the use of manometry probes and other methods, the patient is made aware of his own rectal musculature, which promotes greater self-control over his sphincteric muscle function and motor coordination. The efficacy of this technique is up to 80% of the cases.

Other accompanying factors that can promote the disappearance of this rectal muscular anomaly can be exercise as a routine, a diet rich in fiber and fluids, and the use of laxatives in the early stages after diagnosis. laxatives in the initial stages after diagnosis. It goes without saying that routine psychological management of anxiety and stress disorders, if present, will also be essential in dealing with 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 closely linked to the emotional and mental health of the patient, since, as we have already mentioned, it is linked to situations of anxiety, stress and depression.As we have already mentioned, 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 first of all, it is necessary to rule out any other disease linked to metabolic or physical processes.

Bibliographic references:

• Aisa, Á. P., Chaves, A. Í., Lanagrán, M. L., Fernandez, M. L. M., & Rodríguez, P. J. R. (2019). Session III: Predictors of defecation biofeedback response factors in defecatory 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., Jiménez, M. M., Pérez, 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.
• Lanagrán, M. L., Ordoñez, M. R., & Aisa, Á. P. (2013). Diagnostic therapeutic approach in defecatory dyssynergia. Andalusian journal of digestive pathology, 36(4), 231-236.
• Romero, M. T. R. R. C., Gómez, 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., ... & Lopez-Köstner, F. (2014). Outcomes of pelviperineal rehabilitation in patients with pelvic floor dyssynergia. Spanish Surgery, 92(2), 95-99.