You may have picked up on a trend with our posts – pooping matters. Like many of the simple, everyday aspects of our lives, we tend to underestimate the impact of a healthy bowel routine until things go wrong. When the seemingly simple act of pooping stops being so simple, when pooping hurts, when we have to struggle and push and try to navigate the mile long isle of laxatives… it affects our quality of life and our overall health.
As we’ve previously discussed, there are many types and causes of constipation. The topic of today’s post is a form of constipation that I find particularly important: dyssynergic defecation. Important because it is far more common than many realize (studies suggest that dyssynergic defecation accounts for a quarter or more of constipation cases and is likely underdiagnosed), affects persons of all ages, and requires intervention from a pelvic health provider more than any other form of constipation. Changing diet and laxative use probably aren’t going to cut it with this one unfortunately. The good news? Pelvic health providers are here to help!
So what exactly is dyssynergic defecation?
When all is working well, your rectum and abdominal muscles should reflexively squeeze at the same time as your pelvic floor muscles relax. When your rectum and abdominal muscles contract to push the poop out, and you are sitting on the toilet ready to go, the pelvic floor muscles should relax and open the gates to allow poop to come through. In a perfect world, this takes zero thought. Your body sends a signal that it’s time, you sit on the toilet, your rectum, abdominals, and pelvic floor muscles do their intricate dance, and presto: poop. With dyssynergic defecation, the dance rhythm is completely off. By “dyssynergic” we mean that the “synergy” is, well, wrong. Instead of relaxing while the rectum and abdominals push, the pelvic floor muscles decide that “Hey! You know what would be a great thing to do right now? Squeeze the gates shut!”. Spoiler alert, this is not a helpful idea. As wild as it sounds, this flip-flop can happen without our awareness. We may think we are still pooping exactly the way we have since day one, when in actuality our body has decided to do exactly the wrong thing.
Dyssynergic defecation can be diagnosed by an anorectal exam, but specific imaging and testing can provide a more precise diagnosis and give us additional information of what exactly is going on. Testing includes anorectal manometry, balloon expulsion testing, and defecography (Don’t worry! We’ll be doing further posts on what these entail down the road!).
Why did this happen??
If an area of our body has experienced pain with certain activities in the past, the natural response is to tighten to protect. Because of this, dyssynergic defecation often results following a prolong period of time experiencing constipation of any form. Pooping hurt so the pelvic floor muscles started a pattern of squeezing to fight against the pain. What results is worsened constipation that is harder to treat with laxatives alone as well as worsened pain. A viscous cycle of not going ensues. Dyssynergic defecation is also more common during pregnancy and after abdominal surgery or injury when coordination with our abdominals and bowels is already a struggle. Chronic pain and a history of trauma additionally make dyssynergic defecation more likely. Sometimes, as frustrating as it can be, we simply don’t know the “why”. Things were good until they weren’t. The good news is that we can learn to choreograph this pooping dance appropriately once again with the help of pelvic health providers.
What to do?
1. Optimize bowel habits
Let’s start by making things as easy as possible on our body. Appropriate water and fiber intake, regular meals, and physical movement go a long, long way in having soft but formed poops that are easy (well, easier for those with dyssynergic defecation) to pass. Trying to go anytime you feel the urge to go instead of deferring is also important for easier poops and for building the communication system between your bowels and your brain. Additionally, it’s a good idea to sit on the toilet for a few minutes to simply try and go (but no straining!) shortly after meals or exercise when your body is already more likely to want to get poop out.
2. Pooping Posture!
Posture on the toilet also really matters. You want your feet supported and your knees slightly higher than your hips in a relaxed forward position. Products like the “Squatty Potty” are great options to achieve this position and easy to find these days. This position is helpful for everyone, but even more critical for those with dyssynergic defecation. Being in a relaxed deep squat puts the pelvic floor muscles in a position where they are slightly less likely to want to squeeze and makes it less likely for poop to push against the muscles and get stuck behind them. The result is more affective emptying and less straining.
2. Biofeedback
Most commonly used by Pelvic Health PTs, biofeedback training uses surface electrodes (fancy computer stickers that pick up on what the muscles are doing) placed at the anal sphinctor muscles and the abdominal muscles to identify the strategy a person is using to try and poop. Biofeedback can then be used to correct dyssynergic defecation patterns so that your sphinctor muscles relax when you generate abdominal pressure to pass bowel movement. Biofeedback is the gold standard in correcting these dyssyngeric patterns and can be a game changer for actually relearning how to poop affectively and safely.
3. Ensuring your pelvic floor muscles are strong AND able to relax AND coordinated
Promoting overall pelvic health is critical. Your pelvic floor muscles should be strong enough to support everything inside during all of your physcial activities but also flexible enough to stretch and relax easily when needed. They also should be coordinated enough to go between a state of contraction and elongation smoothly and effortlessly. Easy, right? Ok, not so much when you’ve already been struggling with dyssynergia and constipation, but you can get there. Your pelvic health provider will be able to help get you there!
4. Balloon retraining
A balloon catheter is an incredibly helpful device that can be inserted into the rectum to help practice appropriate pushing strategies. It is a narrow and flexible (i.e. not painful!) tube with a soft balloon on the end. It is inserted by your provider when the balloon is deflated and then inflated gently to a size that mimics poop. You then can work with your provider to build sensation, practice coordination, and find the cues to give your body that work for you.
These are some of the amazingly effective ways to address dyssynergic defecation, but keep in mind that your body is, to put it mildly, intricate. So much goes into every task your body does and pooping is no exception. Working with a pelvic health provider to make sure this beautifully intricate system is working as it should is invaluable for resolving your bowel concerns and improving overall quality of life. Reach out anytime with questions about your own pelvic health journey or finding the care you need.