Pelvic floor dysynergy: symptoms, causes and treatment

Pelvic floor dysergy (or defecation dysergy) is a disease that responds to impaired muscle coordinationIn this case, a lack of synchronization between the abdominal contractions and the function of the anal sphincter.

This disease responds to about half of cases of chronic constipation, and therefore, knowing its causes and treatments becomes essential for anyone who experiences irregularities while using the bathroom. Here we show you everything you need to know about it.

    Pelvic floor dysynergy: a functional disorder

    To understand the origin and treatment of pelvic floor dysergy, it is necessary to speak before chronic constipation and its clinical manifestations.

    About constipation and its numbers

    According to various medical portals, constipation is defined as a process based on poor bowel movements, three times a week or less, difficulty in emptying the bowel, Hard and bulky stools or feeling of intestinal impact.

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

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

    • Constipation with normal traffic: the most common, because it represents 60% of cases.
    • Constraint of slowing down traffic, 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 out above, types of constipation can be classified as anatomical (due to structural changes in the body) or functional (Anismos, that is to say by motor incoordination).

    All of this terminology and percentages help us to classify pelvic floor dysergy 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 defect of nonorganic acquired behavior, that is to say that it is not found at birth and does not respond to an anatomical anomaly. Like many other pathologies, we could say that it comes “from the head”.

    the causes

    Pelvic floor dysergy is strongly correlated with common factors in any adult’s life, such as stress and anxiety.

    In addition, there are other factors intrinsic to the person themselves that can promote the onset of chronic constipation, such as gender (women are more prone to this) or ethnicity. Other parameters such as inadequate diet, lack of exercise, aging, low socioeconomic status or depression promote bowel problems.

    Anxiety and stress are also linked to many other gastrointestinal processes, as they have been shown to generate an imbalance of the normal intestinal microbiota (commensal bacteria), thus promoting the appearance of gas, colic and other clinical manifestations. These emotional turmoils so much the order of the day in a busy society are manifested in other ways as well, such as increased heart rate, rapid breathing, tremors, and excessive sweating.

    For all these clinical manifestations (including defecation dysergy), as well as for the negative emotional effect it has on the patient, seeking psychological help in the face of generalized stress and anxiety becomes essential.

      symptoms

      Pelvic floor dysergy is characterized by symptoms that are shared with many other bowel disorders. In other words, that is to say the feeling of incomplete evacuation and repeated bowel movements over time amidst much discomfort, Already named above.

      diagnostic

      The diagnosis of this pathology is very specific, because to find it, it is necessary to exclude dysfunctions of anatomical or metabolic origin (such as diabetes) or constipation resulting from drug use or drug use. To do this, follow a series of specific steps that we show you below.

      1. Physical examination

      First, you need to do a rectal inspection and touch, then thus pathologies of structural origin are excluded. In addition, this touch has a high sensitivity to diagnose pelvic floor dysergy, as it also helps to assess the pressure of the anal muscles both at rest and during exertion.

      It may be necessary to ask the patient to make a “defecation log”, by noting for 15 to 30 days various parameters during his passage to the toilet (use of laxatives, effort of evacuation … etc.)

      2. Bullet expulsion test

      Strange as it may sound, this diagnostic method is based on the rectal introduction of a probe with a swollen ball at its end into the patient. this must make defecation efforts such as would occur during a normal evacuation, And in general, if it takes more than a minute to kick out, it can be a sign of disengagement. This test has demonstrated utility in stellar detection, as it can clearly support the diagnosis in up to 97% of cases.

      3. Anorectal manometry

      This technique involves measuring the pressures in the anus and rectum, both at rest and during continence or defecation. It is based on the placement of a probe, about 10 centimeters rectal depth, which allows the measurement of various parameters, Like now:

      • Tone and symmetry of the smooth rectal muscle.
      • Same values ​​for striated muscle.
      • Rectal reflexes.
      • Rectal tenderness.
      • Rectal distensibility.
      • Defecation maneuver.

      4. Defecography

      The latter detection method, in this case non-invasive, is based on the use of machines specializing in magnetic resonance imaging, which provides images of the various stages of an individual’s defecation. This allows you to assess the functioning of the pelvic muscles and provide information about rectal function.

      All of these diagnostic tests, as we have seen, are aimed at ruling out structural physiological abnormalities and testing the motility of the patient’s rectal muscles.

      treatment

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

      By using manometric probes and other methods, the patient is made aware of his own rectal musculature, which promotes greater self-control of the muscular function of the sphincter and motor coordination. The effectiveness of this technique reaches up to 80% of cases.

      Other accompanying factors that may promote the disappearance of this anomaly of the rectal muscle may be routine exercise, a diet high in fiber and fluids, and the use of laxatives in the first moments after diagnosis. Needless to say, routine psychological suppression of anxiety and stress disorders, if they occur, will also be essential in treating the condition.

      summary

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

      Diagnostic methods for detecting this disease are varied and complex, since in the first place any other disease related to metabolic or physical processes should be excluded.

      Bibliographical references:

      • Aisa, Á. P., Chaves, A. Í., Lanagrán, ML, Fernandez, MLM and Rodríguez, PJR (2019). Session III .: Predictors of the defecation biofeedback response in defecation dysergy. Andalusian Journal of Digestive Pathology, 42 (5), 210-218.
      • Bechiarelli, AA, Ramos-Clemente, MT, Guerrero, PP and Ramos, CR (2016). Constipation. Accredited Continuing Medical Education Program in Medicine, 12 (7), 337-345.
      • Colmenares, GV, Jiménez, MM, Pérez, SR, Cendón, RG, Salgueiro, JV and Alonso, ML (2017). Anorectal training at home as a treatment for encopresis and sphincter energy. Cir Pediatr, 30 years old, 28-32 years old.
      • Garrido, AS, Bermejo, AP, Pom, IJ and Soler, AM (2012). Constipation. Accredited Continuing Medical Education Program in Medicine, 11 (6), 331-336.
      • Lanagrán, ML, Ordóñez, MR and Aisa, To. P. (2013). Therapeutic diagnostic approach in defecation dysergy. Andalusian Journal of Digestive Pathology, 36 (4), 231-236.
      • Romero, MTRC, Gómez, ARC, Almanzor, AV and de la Creu, MS (2018). Defecating dysynergy. Andalusian Journal of Digestive Pathology, 41 (2), 78-83.
      • Wainstein, C., Carrillo, K., Zarate, AJ, Fonts, B., Venegas, M., Quera, R., … and López-Kostner, F. (2014). Results of pelviperineal rehabilitation in patients with pelvic floor dysenergy. Spanish surgery, 92 (2), 95-99.

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