Dyssynergic defecation is a condition where the muscles of the pelvic floor and abdomen do not work together properly for a complete bowel movement. Instead of relaxing and opening, the anal muscles may tighten or not relax enough during an attempt to pass stool, obstructing the process. This functional issue, rather than a structural blockage, is a common cause of chronic constipation, affecting a significant portion of individuals experiencing persistent bowel difficulties. Effective treatments are available to address this muscle coordination problem.
Biofeedback Therapy for Muscle Retraining
Biofeedback therapy is often considered the primary treatment for dyssynergic defecation, focusing on retraining the muscles for proper coordination rather than simply strengthening them. The goal is to teach individuals to relax their pelvic floor muscles while simultaneously applying gentle abdominal pressure to facilitate stool passage.
During a biofeedback session, a trained physical therapist guides the patient through exercises designed to improve muscle control. A small sensor probe, often placed in the rectum, provides real-time visual or auditory feedback on a computer screen. This feedback allows the patient to see or hear how their pelvic floor muscles are responding as they attempt to simulate a bowel movement. The therapist provides immediate guidance, helping the patient learn to relax the anal sphincter and puborectalis muscles while pushing effectively with the abdominal muscles.
Patients typically undergo a series of biofeedback sessions, with an average of 6 to 7 sessions. This structured training helps individuals gain conscious control over muscles that are usually involuntary. Studies have shown high success rates for biofeedback therapy, with improvements reported in 70% to 80% of patients in randomized controlled trials. The benefits of this therapy can be sustained for over two years, making it an effective treatment option.
Complementary Lifestyle and Dietary Adjustments
Alongside formal therapy, at-home strategies can support treatment and improve symptoms. Adjusting toileting posture can make a notable difference in facilitating bowel movements. Elevating the knees above the hips, often achieved by using a small footstool, helps straighten the anorectal angle, which naturally eases stool passage and reduces the need for straining.
Dietary modifications also influence stool consistency. Increasing both soluble and insoluble fiber intake is beneficial, as fiber adds bulk to stool and helps retain water, making stools softer and easier to pass. Adequate hydration, by drinking plenty of fluids throughout the day, complements fiber intake by keeping the stool soft and preventing it from becoming hard and difficult to expel.
Establishing a routine for bowel movements, timed toileting, can also be helpful. This involves attempting a bowel movement at the same time each day, such as 30 minutes after a meal or upon waking. This practice leverages the body’s natural gastrocolic reflex, which is a physiological response that stimulates colonic contractions after food intake, making it an opportune time for a bowel movement. Consistently responding to the urge to defecate, rather than delaying, can also help retrain bowel habits.
Medications and Other Medical Interventions
While biofeedback therapy is generally the preferred approach for dyssynergic defecation, other medical interventions may be considered if biofeedback is not sufficient or available. Laxatives can be used to manage stool consistency, making bowel movements easier, but they do not correct the underlying muscle coordination problem. Osmotic laxatives, such as polyethylene glycol (Miralax), are often favored as they draw water into the colon to soften stool and increase stool frequency. Stimulant laxatives, which work by causing rhythmic contractions in the bowel, should be used with caution due to potential for dependency or side effects with prolonged use.
Botulinum toxin (Botox) injections are another option, particularly for cases where pelvic floor muscles paradoxically contract. Small amounts of botulinum toxin are injected into the pelvic floor muscles, such as the puborectalis or external anal sphincter, to induce temporary relaxation. This relaxation can help reduce the obstruction caused by muscle tightening during defecation. While some studies have shown symptomatic improvement, the efficacy can vary, and temporary fecal incontinence has been reported as a possible adverse effect.
Surgical intervention, such as anorectal myectomy, is considered a very rare and last-resort treatment. This procedure involves surgically altering or removing a small portion of the anal sphincter muscle. Surgery is typically reserved for severe cases where all other conservative and medical treatments, including biofeedback therapy and medication, have failed to provide adequate relief.