Pelvic Floor Dysfunction and Constipation

Hi All:Someone in another thread was talking about pelvic floor dysfunction and constipation. I found some info in the Merck Manual that I thought was interesting. Here are a few paragraphs from a much larger article on constipation. The url for the article is: http://www.merck.com/pubs/mmanual/section3/chapter27/27c.htm DYSCHEZIA(Disordered Evacuation; Dysfunction of Pelvic Floor/Anal Sphincters)Difficulty in defecating, resulting from a lack of coordination of pelvic floor muscles and anal sphincters.Etiology Constipation is caused not only by slow movement through the whole large bowel but also by disturbance of coordinated movements needed for evacuation. Evacuation requires relaxation of the pelvic floor muscles and anal sphincters; otherwise, efforts to defecate will be futile even with severe straining. Pelvic floor dysfunction is a major reason why constipated patients fail to respond to laxatives.Symptoms, Signs, and Diagnosis The patient may sense that stool is present but cannot defecate, even with prolonged straining and digital evacuation. Stools that are not hard may be difficult to pass. Rectal and pelvic examinations show hypertonia of the pelvic floor muscles and anal sphincters, with incomplete voluntary relaxation (anismus) or excessive relaxation (descending perineum). A rectocele or enterocele may be associated but is usually not of prime pathogenic importance. When advanced, a solitary rectal ulcer or varying degrees of rectal prolapse caused by excessive straining may be found. Special x-rays (defecatory proctography) and functional tests of the pelvic floor may locate anatomic abnormalities.Treatment Treatment with laxatives is unsatisfactory. Dyschezia should be considered when standard measures directed toward colonic inertia are unsuccessful. Relaxation exercises and biofeedback can help, although a group approach (physiotherapists, dietitians, behavior therapists, gastroenterologists) may be needed.