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Dyssynergic Constipation

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By: Kellie Dushner PT, DPT Kate Schenk PT, DPT Jessica Reale PT, DPT

While it is not always the topic for polite conversation, the truth of the matter is everyone poops. It is not something to feel ashamed about, or to be hidden from friends and family. In fact, it is estimated that over 4 million Americans suffer from frequent constipation and it is the #1 reason most people seek out care from a GI specialist.

Some may not even realize that they are constipated in the first place. In general, if you have fewer than 3 bowel movements a week or have to spend considerable effort straining and pushing out stool, you may be constipated. There are several reasons why constipation may occur. Medication changes, poor dietary habits, or improper positioning could all be contributing factors.

Dyssynergic Defecation

Dyssynergic defecation occurs when the pelvic floor muscles are not coordinating with the colon to assist in emptying the bowels. Basically, instead of the muscles relaxing to aid in emptying stool, they contract making defecation difficulty (and in some cases painful). Typically, this incoordination of the pelvic floor muscles is paired with poor coordination of the abdominal muscles, and often impaired sensation of the rectum. It is estimated that this type of problem occurs in 40% of people with constipation. Additional symptoms people may experience with this condition include: excessive straining, feeling of incomplete emptying, abdominal bloating, small hard stools, and using fingers to digitally remove stool.

Pelvic floor physical therapy can help!

The good news is that a physical therapist who has specialized training in treating the pelvic floor can help you overcome this very difficult problem.

Treatment often includes:

  • Intravaginal or intrarectal examination and treatment of the pelvic floor muscles to restore range of motion and flexibility and promote strength, endurance and coordination.
  • Behavioral training (diet, fluid intake, toileting posture and bowel routine training) to improve bowel habits
  • Surface EMG biofeedback training to improve muscle coordination
  • Sensory balloon retraining to improve rectal sensation
  • Manual therapy techniques to improve soft tissue and joint mobility and restore function
  • Specific exercise prescription to improve musculoskeletal contributors to bowel dysfunction

Chronic constipation is not normal and can increase your risk for developing other pelvic floor disorders such as urinary incontinence, pelvic organ prolapse, and pelvic pain. If you are currently experiencing constipation, talk with your doctor about seeing a pelvic floor physical therapist!

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