Anismus or dyssynergic defecation is the failure of normal relaxation of
pelvic floor
The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus muscle, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the lev ...
muscles during attempted
defecation. It can occur in both children and adults, and in both men and women (although it is more common in women). It can be caused by physical defects or it can occur for other reasons or unknown reasons. Anismus that has a behavioral cause could be viewed as having similarities with
parcopresis
Parcopresis, also termed psychogenic fecal retention, is the inability to defecate without a certain level of privacy. The level of privacy involved varies from sufferer to sufferer. The condition has also been termed shy bowel. This is to be d ...
, or psychogenic fecal retention.
Symptoms include
tenesmus (the sensation of incomplete emptying of the rectum after defecation has occurred) and
constipation
Constipation is a bowel dysfunction that makes bowel movements infrequent or hard to pass. The stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the bowel movement ...
. Retention of stool may result in fecal loading (retention of a mass of stool of any consistency) or
fecal impaction
A fecal impaction is a solid, immobile bulk of feces that can develop in the rectum as a result of chronic constipation.
A related term is fecal loading which refers to a large volume of stool in the rectum of any consistency. Fecal impaction is ...
(retention of a mass of hard stool). This mass may stretch the walls of the rectum and colon, causing
megarectum and/or
megacolon
Megacolon is an abnormal dilation of the colon (also called the large intestine). This leads to hypertrophy of the colon. The dilation is often accompanied by a paralysis of the peristaltic movements of the bowel. In more extreme cases, the feces ...
, respectively. Liquid stool may leak around a fecal impaction, possibly causing degrees of liquid fecal incontinence. This is usually termed
encopresis
Encopresis is voluntary or involuntary passage of feces outside of toilet-trained contexts (fecal soiling) in children who are four years or older and after an organic cause has been excluded. Children with encopresis often leak stool into thei ...
or soiling in children, and
fecal leakage
Fecal incontinence (FI), or in some forms encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents, both liquid stool elements and mucus, or solid feces. When this loss includes flatus (gas), it is referre ...
, soiling or liquid
fecal incontinence
Fecal incontinence (FI), or in some forms encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents, both liquid stool elements and mucus, or solid feces. When this loss includes flatus (gas), it is referre ...
in adults.
Anismus is usually treated with dietary adjustments, such as
dietary fiber supplementation. It can also be treated with a type of
biofeedback therapy, during which a sensor probe is inserted into the person's
anal canal
The anal canal is the part that connects the rectum to the anus, located below the level of the pelvic diaphragm. It is located within the anal triangle of the perineum, between the right and left ischioanal fossa. As the final functional seg ...
in order to record the pressures exerted by the pelvic floor muscles. These pressures are visually fed back to the patient via a monitor who can regain the normal coordinated movement of the muscles after a few sessions.
Some researchers have suggested that anismus is an over-diagnosed condition, since the standard investigations or
digital rectal examination
Digital rectal examination (DRE; la, palpatio per anum, PPA) is an internal examination of the rectum, performed by a healthcare provider. Prior to a 2018 report from the U.S. Preventive Services Task Force, the DRE was a common and "dreaded" co ...
and
anorectal manometry
Anorectal manometry (ARM) is a medical test used to measure pressures in the anus and rectum and to assess their function. The test is performed by inserting a catheter, that contains a probe embedded with pressure sensors, through the anus and in ...
were shown to cause paradoxical sphincter contraction in healthy controls, who did not have constipation or incontinence.
Due to the invasive and perhaps uncomfortable nature of these investigations, the pelvic floor musculature is thought to behave differently than under normal circumstances. These researchers went on to conclude that paradoxical pelvic floor contraction is a common finding in healthy people as well as in people with chronic constipation and stool incontinence, and it represents a non-specific finding or laboratory artifact related to untoward conditions during examination, and that true anismus is actually rare.
Signs and symptoms
Symptoms include:
* Straining to pass fecal material
*
Tenesmus (a feeling of incomplete evacuation)
* Feeling of anorectal obstruction/blockage
* Digital maneuvers needed to aid defecation
* Difficulty initiating and completing bowel movements
Cause
![(155) Stylized depiction of action of puborectalis sling](https://upload.wikimedia.org/wikipedia/commons/6/64/%28155%29_Stylized_depiction_of_action_of_puborectalis_sling.png)
To understand the cause of anismus, an understanding of normal colorectal anatomy and physiology, including the normal defecation mechanism, is helpful. The relevant anatomy includes: the
rectum, the
anal canal
The anal canal is the part that connects the rectum to the anus, located below the level of the pelvic diaphragm. It is located within the anal triangle of the perineum, between the right and left ischioanal fossa. As the final functional seg ...
and the muscles of the
pelvic floor
The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus muscle, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the lev ...
, especially
puborectalis
The levator ani is a broad, thin muscle group, situated on either side of the pelvis. It is formed from three muscle components: the pubococcygeus, the iliococcygeus, and the puborectalis.
It is attached to the inner surface of each side of the ...
and the
external anal sphincter
The external anal sphincter (or sphincter ani externus ) is a flat plane of skeletal muscle fibers, elliptical in shape and intimately adherent to the skin surrounding the margin of the anus.
Anatomy
The external anal sphincter measures about 8 ...
.
The
rectum is a section of bowel situated just above the anal canal and distal to the
sigmoid colon of the
large intestine
The large intestine, also known as the large bowel, is the last part of the gastrointestinal tract and of the digestive system in tetrapods. Water is absorbed here and the remaining waste material is stored in the rectum as feces before bein ...
. It is believed to act as a reservoir to store stool until it fills past a certain volume, at which time the defecation reflexes are stimulated. In healthy individuals, defecation can be temporarily delayed until it is socially acceptable to
defecate
Defecation (or defaecation) follows digestion, and is a necessary process by which organisms eliminate a solid, semisolid, or liquid waste material known as feces from the digestive tract via the anus. The act has a variety of names ranging fro ...
. In continent individuals, the rectum can expand to a degree to accommodate this function.
The anal canal is the short straight section of bowel between the rectum and the
anus. It can be defined functionally as the distance between the anorectal ring and the end of the
internal anal sphincter. The internal anal sphincter forms the walls of the anal canal. The internal anal sphincter is not under voluntary control, and in normal persons it is contracted at all times except when there is a need to defecate. This means that the internal anal sphincter contributes more to the resting tone of the anal canal than the external anal sphincter. The internal sphincter is responsible for creating a watertight seal, and therefore provides continence of liquid stool elements.
The
puborectalis
The levator ani is a broad, thin muscle group, situated on either side of the pelvis. It is formed from three muscle components: the pubococcygeus, the iliococcygeus, and the puborectalis.
It is attached to the inner surface of each side of the ...
muscle is one of the pelvic floor muscles. It is
skeletal muscle and is therefore under voluntary control. The puborectalis originates on the posterior aspect of the
pubic bone
In vertebrates, the pubic region ( la, pubis) is the most forward-facing ( ventral and anterior) of the three main regions making up the coxal bone. The left and right pubic regions are each made up of three sections, a superior ramus, inferior ...
, and runs backwards, looping around the bowel.
The point at which the rectum joins the anal canal is known as the anorectal ring, which is at the level that the puborectalis muscle loops around the bowel from in front. This arrangement means that when puborectalis is contracted, it pulls the junction of the rectum and the anal canal forwards, creating an angle in the bowel called the anorectal angle. This angle prevents the movement of stool stored in the rectum moving into the anal canal. It is thought to be responsible for gross continence of solid stool. Some believe the anorectal angle is one of the most important contributors to continence.
Conversely, relaxation of the puborectalis reduces the pull on the junction of the rectum and the anal canal, causing the anorectal angle to straighten out. A
squatting posture is also known to straighten the anorectal angle, meaning that less effort is required to defecate when in this position.
Distension of the rectum normally causes the internal anal sphincter to relax (rectoanal inhibitory response, RAIR) and the external anal sphincter initially to contract (rectoanal excitatory reflex, RAER). The relaxation of the internal anal sphincter is an involuntary response. The external anal sphincter, by contrast, is made up of skeletal (or striated muscle) and is therefore under voluntary control. It can contract vigorously for a short time. Contraction of the external sphincter can defer defecation for a time by pushing stool from the anal canal back into the rectum. Once the voluntary signal to defecate is sent back from the brain, the abdominal muscles contract (straining) causing the intra-abdominal pressure to increase. The pelvic floor is lowered causing the anorectal angle to straighten out from ~90
o to <15
o and the external anal sphincter relaxes. The rectum now contracts and shortens in
peristaltic waves, thus forcing fecal material out of the rectum, through the anal canal and out of the anus. The internal and external anal sphincters along with the puborectalis muscle allow the feces to be passed by pulling the anus up over the exiting feces in shortening and contracting actions.
In patients with anismus, the puborectalis and the external anal sphincter muscles fail to relax, with resultant failure of the anorectal angle to straighten out and facilitate evacuation of feces from the rectum. These muscles may even contract when they should relax (paradoxical contraction), and this not only fails to straighten out the anorectal angle, but causes it to become more acute and offer greater obstruction to evacuation.
As these muscles are under voluntary control, the failure of muscular relaxation or paradoxical contraction that is characteristic of anismus can be thought of as either maladaptive behavior or a loss of voluntary control of these muscles. Others claim that puborectalis can become
hypertrophied
Hypertrophy is the increase in the volume of an organ or tissue due to the enlargement of its component cells. It is distinguished from hyperplasia, in which the cells remain approximately the same size but increase in number.Updated by Linda J ...
(enlarged) or
fibrosis
Fibrosis, also known as fibrotic scarring, is a pathological wound healing in which connective tissue replaces normal parenchymal tissue to the extent that it goes unchecked, leading to considerable tissue remodelling and the formation of perma ...
(replacement of muscle tissue with a more fibrous tissue), which reduces voluntary control over the muscle.
Anismus could be thought of as the patient "forgetting" how to push correctly, i.e. straining against a contracted pelvic floor, instead of increasing abdominal cavity pressures and lowering pelvic cavity pressures. It may be that this scenario develops due to stress. For example, one study reported that anismus was strongly associated with sexual abuse in women.
One paper stated that events such as pregnancy, childbirth, gynaecological descent or neurogenic disturbances of the brain-bowel axis could lead to a "functional
obstructed defecation syndrome
Obstructed defecation syndrome (abbreviated as ODS, with many synonymous terms) is a major cause of functional constipation (primary constipation), of which it is considered a subtype. It is characterized by difficult and/or incomplete emptying of ...
" (including anismus).
Anismus may develop in persons with
extrapyramidal motor disturbance due to
Parkinson's disease
Parkinson's disease (PD), or simply Parkinson's, is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms usually emerge slowly, and as the disease worsens, non-motor symptoms becom ...
. This represents a type of
focal dystonia
Focal dystonia, or focal task specific dystonia, is a neurological condition, a type of '' dystonia'', that affects a muscle or group of muscles in a specific part of the body during specific activities, causing involuntary muscular contractions an ...
. Anismus may also occur with
anorectal malformation,
rectocele
In gynecology, a rectocele ( ) or posterior vaginal wall prolapse results when the rectum bulges ( herniates) into the vagina. Two common causes of this defect are childbirth and hysterectomy. Rectocele also tends to occur with other forms of pe ...
,
rectal prolapse
A rectal prolapse occurs when walls of the rectum have prolapsed to such a degree that they protrude out of the anus and are visible outside the body. However, most researchers agree that there are 3 to 5 different types of rectal prolapse, depen ...
and
rectal ulcer.
[
In many cases however, the underlying pathophysiology in patients presenting with obstructed defecation cannot be determined.]
Some authors have commented that the "puborectalis paradox" and "spastic pelvic floor" concepts have no objective data to support their validity. They state that "new evidence showing that defecation is an integrated process of colonic and rectal emptying suggests that anismus may be much more complex than a simple disorder of the pelvic floor muscles."
Complications
Persistent failure to fully evacuate stool may lead to retention of a mass of stool in the rectum (fecal loading), which can become hardened, forming a fecal impaction
A fecal impaction is a solid, immobile bulk of feces that can develop in the rectum as a result of chronic constipation.
A related term is fecal loading which refers to a large volume of stool in the rectum of any consistency. Fecal impaction is ...
or even fecolith
A fecalith is a stone made of feces. It is a hardening of feces into lumps of varying size and may occur anywhere in the intestinal tract but is typically found in the colon. It is also called appendicolith when it occurs in the appendix and is ...
s.
Liquid stool elements may leak around the retained fecal mass, which may lead to paradoxical diarrhoea and/or fecal leakage (usually known as encopresis
Encopresis is voluntary or involuntary passage of feces outside of toilet-trained contexts (fecal soiling) in children who are four years or older and after an organic cause has been excluded. Children with encopresis often leak stool into thei ...
in children and fecal leakage
Fecal incontinence (FI), or in some forms encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents, both liquid stool elements and mucus, or solid feces. When this loss includes flatus (gas), it is referre ...
in adults).
When anismus occurs in the context of intractable encopresis
Encopresis is voluntary or involuntary passage of feces outside of toilet-trained contexts (fecal soiling) in children who are four years or older and after an organic cause has been excluded. Children with encopresis often leak stool into thei ...
(as it often does), resolution of anismus may be insufficient to resolve encopresis. For this reason, and because biofeedback training is invasive, expensive, and labor-intensive, biofeedback training is not recommended for treatment of encopresis with anismus.
The walls of the rectum may become stretched, known as megarectum.[egarectum and anismus: a cause of constipation">]
Diagnosis
In the Rome IV classification, diagnostic criteria for "functional defecation disorders" are as follows:
* Patient must satisfy diagnostic criteria for functional constipation
Functional constipation, known as chronic idiopathic constipation (CIC), is constipation that does not have a physical (anatomical) or physiological (hormonal or other body chemistry) cause. It may have a neurological, psychological or psychosomati ...
and/or irritable bowel syndrome
Irritable bowel syndrome (IBS) is a "disorder of gut-brain interaction" characterized by a group of symptoms that commonly include abdominal pain and or abdominal bloating and changes in the consistency of bowel movements. These symptoms may ...
with constipation.
* During repeated attempts to defecate, there must be features of impaired evacuation, as shown by 2 of the following 3 tests:
** Abnormal balloon expulsion test.
** Abnormal anorectal evacuation pattern with manometry or anal surface electromyography.
** Impaired rectal evacuation by imaging.
2 subcategories exist within the functional defecation disorders category:
* Inadequate defecatory propulsive (F3a): Inadequate propulsive forces as measured with manometry with or without inappropriate contraction of the anal sphincter and/or pelvic floor muscles.
* Dyssynergic defecation (F3b): Inappropriate contraction of the pelvic floor as measured with anal surface EMG or manometry with adequate propulsive forces during attempted defecation.
For all of these Rome-IV diagnoses, diagnostic criteria must have been fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis. The subcategories F3a and F3b are defined by age- and gender-appropriate normal values for the technique.
Previous Rome criteria recommended that anorectal testing is not usually indicated in patients with symptoms until patients have failed conservative treatment (e.g., increased dietary fiber and liquids; elimination of medications with constipating side effects
whenever possible).
Definition
Several definitions have been offered:
* According to the International Classification of Diseases
The International Classification of Diseases (ICD) is a globally used diagnostic tool for epidemiology, health management and clinical purposes. The ICD is maintained by the World Health Organization (WHO), which is the directing and coordinating ...
(ICD-11): "paradoxical contraction or inadequate relaxation of the pelvic floor muscles during attempted defecation".
* According to the Rome-IV classification of functional gastrointestinal disorders: "Inappropriate contraction of the pelvic floor as measured with anal surface EMG or manometry with adequate propulsive forces during attempted defecation".
* According to the American Society of Colon and Rectal Surgeons The American Society of Colon and Rectal Surgeons (ASCRS), formerly the American Proctologic Society, is a professional society for surgeons specializing in colorectal surgery. It is one of the oldest surgical societies, having been established in ...
: "failure of striated muscles of the pelvic floor (puborectalis and external anal sphincter) to relax appropriately during attempted defecation.
* "Absence of normal relaxation of pelvic floor muscles during defecation, resulting in rectal outlet obstruction".
* "Malfunction (a focal dystonia
Focal dystonia, or focal task specific dystonia, is a neurological condition, a type of '' dystonia'', that affects a muscle or group of muscles in a specific part of the body during specific activities, causing involuntary muscular contractions an ...
) of the external anal sphincter
The external anal sphincter (or sphincter ani externus ) is a flat plane of skeletal muscle fibers, elliptical in shape and intimately adherent to the skin surrounding the margin of the anus.
Anatomy
The external anal sphincter measures about 8 ...
and puborectalis muscle
The levator ani is a broad, thin muscle group, situated on either side of the pelvis. It is formed from three muscle components: the pubococcygeus, the iliococcygeus, and the puborectalis.
It is attached to the inner surface of each side of the ...
during defecation".
* " ..failure of [the external anal sphincter
The external anal sphincter (or sphincter ani externus ) is a flat plane of skeletal muscle fibers, elliptical in shape and intimately adherent to the skin surrounding the margin of the anus.
Anatomy
The external anal sphincter measures about 8 ...
and puborectalis
The levator ani is a broad, thin muscle group, situated on either side of the pelvis. It is formed from three muscle components: the pubococcygeus, the iliococcygeus, and the puborectalis.
It is attached to the inner surface of each side of the ...
] muscle[s] to relax, resulting in maintenance of the anorectal angle and the difficulty with initiating and completing bowel movements".
* " ..failure of relaxation (or paradoxic contraction) of the puborectalis muscle sling during defaecation, attempted defaecation or straining."
Digital rectal examination
Physical examination can rule out anismus (by identifying another cause) but is not sufficient to diagnose anismus.
Anorectal manometry
The measurement of pressure
Pressure (symbol: ''p'' or ''P'') is the force applied perpendicular to the surface of an object per unit area over which that force is distributed. Gauge pressure (also spelled ''gage'' pressure)The preferred spelling varies by country and e ...
s within the rectum and anus with a manometer
Pressure measurement is the measurement of an applied force by a fluid (liquid or gas) on a surface. Pressure is typically measured in units of force per unit of surface area. Many techniques have been developed for the measurement of pressu ...
(pressure-sensing probe).
Evacuation proctography
defecating proctogram
Defecography (also known as proctography, defecating/defecation proctography, evacuating/evacuation proctography or dynamic rectal examination) is a type of medical radiological imaging in which the mechanics of a patient's defecation are visual ...
, and MRI defecography
Classification
Anismus can be subcategorized into 4 types based on the results of anorectal manometry testing:
* Type 1: The patient can generate and adequate rise in intra-abdominal pressure, yet there is a paradoxical increase in anal sphincter pressures.
* Type 2: The patient is unable to generate an adequate rise in intrarectal pressures and has a paradoxical anal sphincter contraction.
* Type 3: The patient can generate an adequate intraabdominal pressure but either has absent or incomplete (<20%) anal sphincter relaxation.
* Type 4: The patient is unable to generate and adequate pushing force and demonstrates an absent or incomplete sphincter relaxation.
Anismus is classified as a functional defecation disorder. It is also a type of rectal outlet obstruction (a functional outlet obstruction). Where anismus causes constipation, it is an example of functional constipation
Functional constipation, known as chronic idiopathic constipation (CIC), is constipation that does not have a physical (anatomical) or physiological (hormonal or other body chemistry) cause. It may have a neurological, psychological or psychosomati ...
. Many authors describe an "obstructed defecation syndrome
Obstructed defecation syndrome (abbreviated as ODS, with many synonymous terms) is a major cause of functional constipation (primary constipation), of which it is considered a subtype. It is characterized by difficult and/or incomplete emptying of ...
", of which anismus is a cause.
The Rome II classification functional defecation disorders were divided into 3 types, however the symptoms the patient experiences are identical.
* Type I: paradoxical contraction of the pelvic floor muscles during attempted defecation
* Type II: inadequate propulsive forces during attempted defecation (inadequate defecatory propulsion)
* Type III: impaired relaxation with adequate propulsion
It can be seen from the above classification that many of the terms that have been used interchangeably with anismus are inappropriately specific and neglect the concept of impaired propulsion. Similarly, some of the definitions that have been offered are also too restrictive.
Rectal cooling test
The rectal cooling test is suggested to differentiate between rectal inertia and impaired relaxation/paradoxical contraction
Other techniques include manometry, balloon expulsion test, evacuation proctography (see defecating proctogram
Defecography (also known as proctography, defecating/defecation proctography, evacuating/evacuation proctography or dynamic rectal examination) is a type of medical radiological imaging in which the mechanics of a patient's defecation are visual ...
), and MRI defecography. Diagnostic criteria are: fulfillment of criteria for functional constipation
Functional constipation, known as chronic idiopathic constipation (CIC), is constipation that does not have a physical (anatomical) or physiological (hormonal or other body chemistry) cause. It may have a neurological, psychological or psychosomati ...
, manometric and/or EMG and/or radiological evidence (2 out of 3), evidence of adequate expulsion force, and evidence of incomplete evacuation. Recent dynamic imaging studies have shown that in persons diagnosed with anismus the anorectal angle during attempted defecation is abnormal, and this is due to abnormal (paradoxical) movement of the puborectalis muscle
The levator ani is a broad, thin muscle group, situated on either side of the pelvis. It is formed from three muscle components: the pubococcygeus, the iliococcygeus, and the puborectalis.
It is attached to the inner surface of each side of the ...
.
Treatment
Initial steps to alleviate anismus include dietary adjustments and simple adjustments when attempting to defecate. Supplementation with a bulking agent such as psyllium
Psyllium , or ispaghula , is the common name used for several members of the plant genus '' Plantago'' whose seeds are used commercially for the production of mucilage. Psyllium is mainly used as a dietary fiber to relieve symptoms of both const ...
3500 17 mg per day will make stool more bulky, which decreases the effort required to evacuate. Similarly, exercise and adequate hydration may help to optimise stool form. The anorectal angle has been shown to flatten out when in a squatting position
Squatting is a versatile posture where the weight of the body is on the feet but the knees and hips are bent. In contrast, sitting involves taking the weight of the body, at least in part, on the buttocks against the ground or a horizontal object. ...
, and is thus recommended for patients with functional outlet obstruction like anismus. If the patient is unable to assume a squatting postures due to mobility issues, a low stool can be used to raise the feet when sitting, which effectively achieves a similar position.
Treatments for anismus include biofeedback retraining, botox injections, and surgical resection. Anismus sometimes occurs together with other conditions that limit (see contraindication
In medicine, a contraindication is a condition that serves as a reason not to take a certain medical treatment due to the harm that it would cause the patient. Contraindication is the opposite of indication, which is a reason to use a certain tre ...
) the choice of treatments. Thus, thorough evaluation is recommended prior to treatment.
Biofeedback training for treatment of anismus is highly effective and considered the gold standard therapy by many.
Others however, reported that biofeedback had a limited therapeutic effect.
Injections of botulin toxin type-A into the puborectalis muscle
The levator ani is a broad, thin muscle group, situated on either side of the pelvis. It is formed from three muscle components: the pubococcygeus, the iliococcygeus, and the puborectalis.
It is attached to the inner surface of each side of the ...
are very effective in the short term, and somewhat effective in the long term. Injections may be helpful when used together with biofeedback training.
Historically, the standard treatment was surgical resection of the puborectalis muscle, which sometimes resulted in fecal incontinence. Recently, partial resection (partial division) has been reported to be effective in some cases.
Etymology and synonyms
Paradoxical anal contraction during attempted defecation in constipated patients was first described in a paper in 1985, when the term anismus was first used. The researchers drew analogies to a condition called vaginismus
Vaginismus is a condition in which involuntary muscle spasm interferes with vaginal intercourse or other penetration of the vagina. This often results in pain with attempts at sex. Often, it begins when vaginal intercourse is first attempted.
...
, which involves paroxysmal (sudden and short lasting) contraction of pubococcygeus (another muscle of the pelvic floor). These researchers felt that this condition was a spastic dysfunction of the anus, analogous to 'vaginismus'. However, the term anismus implies a psychogenic etiology, which is not true although psychological dysfunction has been described in these patients. Hence:
Latin ''ani'' - "of the anus"
Latin ''spasmus'' - "spasm"
(Derived by extrapolation with the term vaginismus, which in turn is from the Latin ''vagina'' - "sheath" + ''spasmus'' - "spasm")
Many terms have been used synonymously to refer to this condition, some inappropriately. The term "anismus" has been criticised as it implies a psychogenic
A psychogenic effect is one that originates from the brain instead of other physical organs (i.e. the cause is psychological rather than physiological) and may refer to:
* Psychogenic pain
*Psychogenic disease
* Psychogenic amnesia
*Psychogenic co ...
cause. In the most widely accepted classification systems (ICD-11
The ICD-11 is the eleventh revision of the International Classification of Diseases (ICD). It replaces the ICD-10 as the global standard for recording health information and causes of death. The ICD is developed and annually updated by the World H ...
and Rome-IV, the term "dyssynergic defecation" is preferred. As stated in the Rome II criteria, the term "dyssynergic defecation" is preferred to "pelvic floor dyssynergia" because many patients with dyssynergic defecation do not report sexual or urinary symptoms, meaning that only the defecation mechanism is affected.
Other synonyms include:
* Dyskinetic puborectalis
* Puborectalis syndrome
* Paradoxical puborectalis
* Nonrelaxing puborectalis
* Paradoxal puborectal contraction
* Spastic pelvic floor syndrome,
* Anal sphincter dyssynergia Help for Constipation
/ref>
* Paradoxical pelvic floor contraction
See also
* Defecation postures
Humans use one of two types of defecation postures to defecate: squatting and sitting. People use the squatting postures when using squat toilets or when defecating in the open in the absence of toilets. The sitting posture on the other hand i ...
* Dystonia
* Parcopresis
Parcopresis, also termed psychogenic fecal retention, is the inability to defecate without a certain level of privacy. The level of privacy involved varies from sufferer to sufferer. The condition has also been termed shy bowel. This is to be d ...
References
External links
{{Digestive system diseases
Gastrointestinal tract disorders
Colorectal surgery