Overview
Defecation disorder refers to the state of not having a smooth bowel movement and not being able to pass stools smoothly, including constipation, unpleasant bowel movement, feeling of incomplete bowel movement, feeling of falling, difficulty in defecation, prolonged straining to defecate, irregularity in bowel habits, reduction in the frequency of defecation, and other abnormalities of the bowels. Any defecation accompanied by the above symptoms are defecation disorders. Since patients with constipation with outlet obstruction are often accompanied by the above symptoms of defecation disorder, constipation with outlet obstruction is closely related to defecation disorder.
Defecation disorder can be seen in organic anorectal lesions, such as rectal stenosis, anorectal cancer, etc.; can also be seen in functional anorectal diseases, such as rectal proptosis, rectal mucosal prolapse, puborectalis muscle syndrome, pelvic floor and perineal descent syndrome, pelvic floor failure syndrome, etc., which may result in functional outlet obstruction type constipation and defecation disorder. Bowel movement disorders caused by functional anorectal diseases are called functional bowel movement disorders.
Causes
The cause of functional dyspareunia is not fully understood. Many studies have shown that its onset may be related to the following factors.
1. Anal spasm and pelvic floor muscle spasm
Anal spasm, firstly proposed by Preston et al, that due to the pelvic floor transverse striated muscle can not relax, when defecation puborectalis muscle instead of contraction, can be manifested as difficult defecation, have a sense of incomplete defecation, etc. Ron et al believe that anal spasm is a common cause of outlet obstruction. Pelvic floor muscle spasm, mainly the neuromuscular response caused by mental factors, as well as spasm caused by overload contraction.
2. Anorectal sensory disorder
Difficulty in defecation may be caused by prolonged straining to defecate, aging, or damage to the perineal nerve innervating the external anal sphincter, urethral sphincter, and puborectal muscle during childbirth.
3. Pelvic floor relaxation
Long-term chronic increase in abdominal pressure (such as childbirth, frequent defecation with excessive force, etc.), can lead to a decrease in the tension of the anus muscle, atrophy and subsidence, resulting in the original encapsulation in the anus muscle tunnel in the anal canal most of the exposure, defecation, the pelvic floor drop more than the degree of the normal range of the following, the abdominal pressure closure of the anal canal and caused by the difficulty in defecation.
Symptoms
The main symptom is constipation with outlet obstruction. In addition, there may be swelling, dampness and itching of the skin around the anus; sometimes there is frequent urination, urgency, painful urination and tension incontinence; sometimes there is severe swelling and little change in bowel movement, but accompanied by menstrual irregularities, excessive leukorrhea, lumbosacral pain, and painful and uncomfortable sexual intercourse.
Examination
For patients with constipation who are suspected of having anorectal disease, anorectal fingerprinting should be performed to help understand the presence of rectal masses, fecal storage, and sphincter function. Routine tests such as fecal examination and occult blood test are performed. Relevant biochemical tests are performed if necessary. Colonoscopy or imaging is helpful in determining the presence or absence of organic etiology.
Diagnosis
1. The patient must meet the diagnostic criteria for functional constipation (see Functional Constipation).
2. At least two of the following are present during repeated forceful defecation:
(1) Evidence of impaired defecation function on balloon ejection test or imaging.
(2) Anorectal manometry, imaging, or EMG reveals abnormal contraction of pelvic floor muscles (e.g., anal sphincter or puborectalis), or anal sphincter relaxation of less than 20% of resting state.
(3) Inadequate peristalsis on anorectal manometry or imaging evaluation.
Symptomatic episodes in the last 3 of at least 6 months prior to diagnosis.
Diagnosis may be aided by history and symptoms of oro-obstructive constipation in conjunction with a diagnostic examination of the abdomen. Relevant biochemical tests are performed if necessary. Colonoscopy or imaging is helpful in determining the presence or absence of an organic etiology.
Differential diagnosis
It should be differentiated from defecation disorders caused by tumor, inflammation, endocrine, psychogenic factors and psychiatric and narcotic drugs.
Treatment
There is no effective treatment for this disease. In addition to correcting bad dietary habits and defecation habits, oral medication, biofeedback therapy, intra-anal local medication, acupuncture and other traditional Chinese and Western medicine combined treatment have certain efficacy.
1. Adjustment of living habits
Avoid the use of drugs that cause constipation and bad bowel habits. Increase the intake of fiber and fruits as well as the amount of exercise. Reasonable use of laxatives and toilet training.
2. Use of laxatives
When dietary modification is not effective, consider taking general laxatives, such as osmotic laxatives, senna and stool softeners.
3. Biofeedback therapy
Biofeedback therapy, in essence, is the use of sound or image feedback to stimulate the brain to regulate the body’s functions, training patients to learn to control the occurrence of a phenomenon. Biofeedback techniques currently used include EMG-mediated biofeedback, stress-measurement-mediated biofeedback, and other methods of instructing patients to control muscle activity.
4. Surgery
Surgery can be considered for patients with typical symptoms who have failed conservative treatment.
5. Traditional Chinese Medicine (TCM)
Acupuncture, massage, herbal acupoints, abdominal flash cupping, etc. are all effective for this disease.