gastrointestinal disorders
Constipation
Dyschezia
Dyschezia (which also may be referred to as dyssynergia, disordered evacuation, dysfunction of pelvic floor or anal sphincters, or functional defecatory disorders) is difficulty defecating. Patients sense the presence of stool and the need to defecate but are unable. It results from a lack of coordination of pelvic floor muscles and anal sphincters. Diagnosis requires anorectal testing. Treatment is difficult, but biofeedback may be of benefit. Normally, when a person tries to defecate, rectal pressure rises in coordination with relaxation of the external anal sphincter. This process may be affected by one or more dysfunctions (eg, impaired rectal contraction, excessive contraction of the abdominal wall, paradoxic anal contraction, failure of anal relaxation) of unclear etiology. Functional defecatory disorders may manifest at any age. In contrast, Hirschsprung Disease , which is due to an absent recto-anal inhibitory reflex, is almost always diagnosed in infancy or childhood. People with The patient may or may not sense that stool is present in the rectum. Despite prolonged straining, evacuation is tedious or impossible, frequently even for soft stool or enemas. Patients may complain of anal blockage and may digitally remove stool from their rectum or manually support their perineum or splint the vagina to evacuate. Actual stool frequency may or may not be decreased. Anorectal manometry and rectal balloon expulsion Rectal and pelvic examinations may reveal hypertonia of the pelvic floor muscles and anal sphincters. With bearing down, patients may not demonstrate the expected anal relaxation and perineal descent. With excessive straining, the anterior rectal wall prolapses into the vagina in patients with impaired anal relaxation; thus rectoceles are usually a secondary rather than a primary disturbance. Long-standing dyschezia with chronic straining may cause a solitary rectal ulcer or varying degrees of rectal prolapse or excessive perineal descent or an enterocoele. Anorectal manometry and rectal balloon expulsion, occasionally supplemented by defecatory or magnetic resonance proctography, are necessary to diagnose the condition. (See also the American College of Gastroenterology's2021 clinical guidelines for the management of benign anorectal disorders.) Biofeedback Because treatment with laxatives is unsatisfactory, it is important to assess anorectal functions in patients with refractory Constipation . 