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Painful defecation
Last reviewed: 23.04.2024
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Dysceia is a difficult stool. In case of dyspepsia, patients are unable to defecate, despite the presence of stool and the need for defecation. This is due to a disruption in the coordination of the pelvic floor muscles and the anal sphincter. The diagnosis is made with anorectal manometry. Treatment is complex, but the principle of biofeedback can be effective.
[Causes of painful defecation
Normally, during defecation, the increase in pressure in the rectum is coordinated with the relaxation of the external anal sphincter. This process can be disturbed by weakening the contraction of the rectum, the paradoxical contraction of the anal sphincter or its relaxation. Somatic causes include prolapse of the rectum and Hirschsprung's disease (reduction of the number of intra-wall ganglia or their absence - aganglion). However, in most patients, the disorders are most likely related to acquired psychoneurological disorders or the manifestation of irritable bowel syndrome; in 1/3 of these patients, neuropsychiatric problems are traced from childhood.
Symptoms, signs and diagnosis of painful defecation
Patients have a feeling of urge to defecate, but even with prolonged straining and attempting to remove feces, defecation is difficult. Difficulties arise even in the presence of feces of a soft consistency. The frequency of calls does not change or can be reduced.
Studies of the rectum and pelvis can reveal an increased muscle tone of the pelvic floor and anal sphincter. When straining, patients may not be expected to relax the anus and lower the perineum. There may be rectocele or enterocele, but they usually do not have a major pathogenetic significance. Prolonged disceases with chronic straining can lead to the appearance of a solitary ulcer of the rectum or prolapse of the rectum to varying degrees. Special X-ray studies (defecation proctography), anorectal manometry and balloon study of visceral sensitivity allow to establish the cause.
Treatment of painful defecation
Treatment with laxatives is ineffective. Relaxation exercises and biological feedback can be effective, although a complex approach is required (physiotherapist, dietitian, psychotherapist, gastroenterologist).