Anismus

Anismus (or dyssynergic defecation) refers to the failure of the normal relaxation of pelvic floor muscles during attempted defecation.

Anismus 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, or psychogenic fecal retention.

Symptoms include tenesmus (a sensation where a mass is felt to remain in rectum after defecation) and constipation. Retention of stool may result in fecal loading (retention of a mass of stool of any consistency) or fecal impaction (retention of a mass of hard stool). This mass may stretch the walls of the rectum and colon, causing megarectum and/or megacolon respectively. Liquid stool may leak around a fecal impaction, possibly causing degrees of liquid fecal incontinence. This is usually termed encopresis or soiling in children, and fecal leakage, soiling or liquid fecal incontinence in adults.

Anismus is usually treated with adjustments to the diet, such as dietary fiber supplementation. It can also be treated with a type of biofeedback therapy, where a sensor probe is inserted in the patient's anal canal and records the pressures exerted by the pelvic floor muscles. These pressures are visually fed back to the patient via a monitor who is able to 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 and anorectal manometry 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 common finding in healthy controls as well as in patients 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.

Read more about AnismusEtymology & Synonyms, Definition, Classification, Symptoms, Etiology, Diagnosis, Treatment

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Anismus - Treatment
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