J Neurogastroenterol Motil.  2016 Jul;22(3):423-435. 10.5056/jnm16060.

Diagnosis and Treatment of Dyssynergic Defecation

• Rao SS
• Patcharatrakul T

• KMID: 2327947
• DOI: http://doi.org/10.5056/jnm16060

Abstract

Dyssynergic defecation is common and affects up to one half of patients with chronic constipation. This acquired behavioral problem is due to the inability to coordinate the abdominal and pelvic floor muscles to evacuate stools. A detailed history, prospective stool diaries, and a careful digital rectal examination will not only identify the nature of bowel dysfunction, but also raise the index of suspicion for this evacuation disorder. Anorectal physiology tests and balloon expulsion test are essential for a diagnosis. Newer techniques such as high-resolution manometry and magnetic resonance defecography can provide mechanistic insights. Recently, randomized controlled trials have shown that biofeedback therapy is more effective than laxatives and other modalities, both in the short term and long term, without side effects. Also, symptom improvements correlated with changes in underlying pathophysiology. Biofeedback therapy has been recommended as the first-line of treatment for dyssynergic defecation. Here, we provide an overview of the burden of illness and pathophysiology of dyssynergic defecation, and how to diagnose and treat this condition with biofeedback therapy.

Keyword

Constipation; Defecation; Laxatives

MeSH Terms

Biofeedback, Psychology
Constipation
Cost of Illness
Defecation*
Defecography
Diagnosis*
Digital Rectal Examination
Humans
Laxatives
Manometry
Muscles
Pelvic Floor
Physiology
Problem Behavior
Prospective Studies
Laxatives