Pelvic Floor Nonrelaxation: Approach to Evaluation and Treatment

Abstract

Dyssynergic defecation can be a complex, burdensome condition. A multidisciplinary approach to these patients is often indicated based on concomitant pathology or symptomatology across the pelvic organs. Escalating treatment options should be based on shared decision making and include medical and lifestyle optimization, pelvic floor physical therapy with biofeedback, Botox injection, sacral neuromodulation, rectal irrigation, and surgical diversion.

Keywords

anismus - Botulinum toxin - dyssynergic defecation - pelvic floor - sacral neuromodulation

Disclosures

Authors have nothing to disclose.

Publication History

Article published online:
04 September 2020

• References

• 1 Suares NC, Ford AC. Prevalence of, and risk factors for, chronic idiopathic constipation in the community: systematic review and meta-analysis. Am J Gastroenterol 2011; 106 (09) 1582-1591 , quiz 1581, 1592
• 2 Rao SSC, Patcharatrakul T. Diagnosis and treatment of dyssynergic defecation. J Neurogastroenterol Motil 2016; 22 (03) 423-435
• 3 Bordeianou LG, Carmichael JC, Paquette IM. et al. Consensus statement of definitions for anorectal physiology testing and pelvic floor terminology (revised). Dis Colon Rectum 2018; 61 (04) 421-427
• 4 Rao SSC. Dyssynergic defecation. Gastroenterol Clin North Am 2001; 30 (01) 97-114
• 5 Rao SSC, Tuteja AK, Vellema T, Kempf J, Stessman M. Dyssynergic defecation: demographics, symptoms, stool patterns, and quality of life. J Clin Gastroenterol 2004; 38 (08) 680-685
• 6 Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD. A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 1996; 39 (06) 681-685
• 7 Marquis P, De La Loge C, Dubois D, McDermott A, Chassany O. Development and validation of the Patient Assessment of Constipation Quality of Life questionnaire. Scand J Gastroenterol 2005; 40 (05) 540-551
• 8 Minguez M, Herreros B, Sanchiz V. et al. Predictive value of the balloon expulsion test for excluding the diagnosis of pelvic floor dyssynergia in constipation. Gastroenterology 2004; 126 (01) 57-62
• 9 Shorvon PJ, McHugh S, Diamant NE, Somers S, Stevenson GW. Defecography in normal volunteers: results and implications. Gut 1989; 30 (12) 1737-1749
• 10 Winnard KP, Dmitrieva N, Berkley KJ. Cross-organ interactions between reproductive, gastrointestinal, and urinary tracts: modulation by estrous stage and involvement of the hypogastric nerve. Am J Physiol Regul Integr Comp Physiol 2006; 291 (06) R1592-R1601
• 11 Rudick CN, Chen MC, Mongiu AK, Klumpp DJ. Organ cross talk modulates pelvic pain. Am J Physiol Regul Integr Comp Physiol 2007; 293 (03) R1191-R1198
• 12 Pandeva I, Biers S, Pradhan A, Verma V, Slack M, Thiruchelvam N. The impact of pelvic floor multidisciplinary team on patient management: the experience of a tertiary unit. J Multidiscip Healthc 2019; 12: 205-210
• 13 Poleshuck EL, Dworkin RH, Howard FM. et al. Contributions of physical and sexual abuse to women's experiences with chronic pelvic pain. J Reprod Med 2005; 50 (02) 91-100
• 14 Arnouk A, De E, Rehfuss A, Cappadocia C, Dickson S, Lian F. Physical, complementary, and alternative medicine in the treatment of pelvic floor disorders. Curr Urol Rep 2017; 18 (06) 47 . Doi: 10.1007/s11934-017-0694-7
• 15 Emile SH, Elfeki HA, Elbanna HG. et al. Efficacy and safety of botulinum toxin in treatment of anismus: a systematic review. World J Gastrointest Pharmacol Ther 2016; 7 (03) 453-462
• 16 Shafik A, El-Sibai O. Botulin toxin in the treatment of nonrelaxing puborectalis syndrome. Dig Surg 1998; 15 (04) 347-351
• 17 Ron Y, Avni Y, Lukovetski A. et al. Botulinum toxin type-A in therapy of patients with anismus. Dis Colon Rectum 2001; 44 (12) 1821-1826
• 18 Maria G, Cadeddu F, Brandara F, Marniga G, Brisinda G. Experience with type A botulinum toxin for treatment of outlet-type constipation. Am J Gastroenterol 2006; 101 (11) 2570-2575
• 19 Zhang Y, Wang ZN, He L. et al. Botulinum toxin type-A injection to treat patients with intractable anismus unresponsive to simple biofeedback training. World J Gastroenterol 2014; 20 (35) 12602-12607
• 20 Srinivasaiah N, Marshall J, Gardiner AJ, Monson R, Duthie G. Rectal irrigation (RI) in the treatment of defecation disorders – a retrospective evaluation of a prospective database. Clin Surg 2016; 1 (1227): 1-7
• 21 Corbett P, Denny A, Dick K, Malone PS, Griffin S, Stanton MP. Peristeen integrated transanal irrigation system successfully treats faecal incontinence in children. J Pediatr Urol 2014; 10 (02) 219-222
• 22 Christensen P, Krogh K. Transanal irrigation for disordered defecation: a systematic review. Scand J Gastroenterol 2010; 45 (05) 517-527
• 23 Gladman MA, Lunniss PJ, Scott SM, Swash M. Rectal hyposensitivity. Am J Gastroenterol 2006; 101 (05) 1140-1151
• 24 Scott SM, van den Berg MM, Benninga MA. Rectal sensorimotor dysfunction in constipation. Best Pract Res Clin Gastroenterol 2011; 25 (01) 103-118
• 25 Kamm MA, Dudding TC, Melenhorst J. et al. Sacral nerve stimulation for intractable constipation. Gut 2010; 59 (03) 333-340
• 26 Knowles CH, Thin N, Gill K. et al. Prospective randomized double-blind study of temporary sacral nerve stimulation in patients with rectal evacuatory dysfunction and rectal hyposensitivity. Ann Surg 2012; 255 (04) 643-649