Dyschezia is a defecation disorder caused by a coordination disorder of the anal sphincter. Patients feel an urge to defecate but have difficulty defecating. Treatment is determined by the primary cause of the muscular coordination disorder.
What is dyschezia?
The anal sphincter or sphincter is a ring-shaped muscle that completely seals the bowel. The forward and backward flow of digested food is prevented by the muscle. The sphincter is composed of smooth muscle and thus only small parts of it are accessible to voluntary action. Nevertheless, the anal sphincter, like any other muscle, can be affected by coordination disorders. In most cases, coordination disorders of the muscle are accompanied by coordinative weakness of the entire pelvic floor musculature. So-called dyschezia is a coordination disorder of the anal sphincter muscle that leads to difficulty in defecation. Affected individuals feel the urge to defecate, but are unable to defecate regularly because of the coordinative disorder of the muscle. The primary cause of the inability to defecate may be related to various diseases in the context of dyschezia. Thus, dyschezia is merely a symptom, not the primary disease itself.
Causes
During defecation, pressure within the rectum increases and there is concomitant relaxation of the external sphincter. Decreased rectal contraction or increased tone of the sphincter disrupts this process and causes dyschezia. The phenomenon is often due to a rectal prolapse that has been experienced, i.e., an intussusception of the rectal wall that occurred in the past. However, the phenomenon may also indicate a larger disease framework, such as Hirschsprung’s disease or irritable bowel syndrome. Just as often, dyschezia occurs in the context of hemorrhoidal disorders, anal fissures or clysms. In individual cases, the symptoms of dyschezia for women also occur cycle-dependently. In this case, endometriosis between the vagina and rectum is usually the cause. General pelvic floor problems are not usually a cause of dyschezia, but may accompany the phenomenon. In many cases, patients with dyschezia are also individuals who frequently suppress their voiding reflex. In addition, voiding dysfunction has often been observed in patients who have received regular enemas in the past.
Symptoms, complaints, and signs
Patients with dyschezia experience more or less pain during defecation. The quality of the stool passed alternates between diarrhea and constipation. Affected individuals often experience severe flatulence. Spasms sometimes occur in the sphincter muscle. In particularly severe cases, the urge to defecate itself causes pain, which is then referred to as tenesmus. In individual cases, nausea is also present, i.e. a feeling of nausea from the gastrointestinal tract accompanied by nausea. In almost all cases, the pelvic floor muscles are also affected by the coordination disorder of the anal sphincter. All other accompanying symptoms of dyschezia depend on the primary cause in each individual case. This also applies to the course of the symptoms. In the case of causative endometriosis between the vagina and the rectum, for example, the symptoms do not occur persistently, but run in cycles and change during the female cycle. In individual cases, patients with dyschezia also suffer from a rectocele or enterocele. However, this phenomenon is neither a binding diagnostic criterion nor causally significant.
Diagnosis
To diagnose dyschezia, an examination of the pelvic area and rectum is ordered to clarify hypertonia of the pelvic muscles and anal muscles. In most cases, the physician already finds initial indications of dyschezia in the medical history, for example, a reclined rectal colps or a disease such as Hirschsprung’s disease. In addition to testing the tone of the muscles in the pelvic region, the physician usually orders a defecation proctography to confirm the diagnosis of dyschezia. Anorectal manometry or balloon expulsion can also be used to confirm the diagnosis. Dyschezia is attributed to a primary disease during the diagnostic process. The prognosis for the patient depends on this primary cause.
Complications
Dyschezia usually results in very unpleasant discomfort and complications. Even if the affected person feels the urge to empty the bowel in the process, it cannot move the sphincter directly due to the disorder. This disorder can lead not only to physical depression, but also to severe psychological depression. Usually, flatulence and diarrhea also occur. The sphincter muscle hurts after each bowel movement. This pain usually intensifies when the affected person has to visit the toilet in an increased manner due to diarrhea. Complications occur primarily when sufferers use laxatives more frequently. These agents can cause addictive behavior and are relatively unhealthy for the human body. They should be used only in emergencies. As a rule, treatment is carried out according to the underlying disease. This may include surgical intervention to eliminate the complications of the sphincter. If there are psychological complaints due to the dyschezia, a psychologist can be consulted in parallel. Often anxiety or panic attacks occur. These can usually be treated relatively well. Life expectancy is not reduced by the disease.
When should one go to the doctor?
If discomfort recurs during bowel movements, the family doctor or a gastroenterologist should be consulted. The typical signs of dyschezia – including severe flatulence, diarrhea, constipation and pain – require medical clarification in any case. Otherwise, further complications may occur, which are usually associated with a rapid decline in the quality of life for the person affected. That is why even the first signs of dyschezia should lead to a doctor. If the diarrhea causes increasing pain during bowel movements, this must be treated immediately by a gastroenterologist. Patients with an existing gastrointestinal disease as well as elderly people and infants should immediately present to a doctor or pediatrician with dyschezia. To rule out a severe course of the disease, the defecation disorder must be treated comprehensively. Good follow-up care is then indicated. If the dyschezia is accompanied by psychological problems, a psychologist can be consulted. The anxiety and panic attacks that often occur are as unproblematic as the disease itself if treated quickly.
Treatment and therapy
For symptomatic treatment of dyschezia, patients often use laxatives. Not only are laxatives addictive, however, but moreover, their use in the context of dyschezia is only unsatisfactory and in no way eliminates the primary cause. To cure dyschezia permanently, the cause of the symptoms must be eliminated. Thus, causative treatment is clearly preferred to symptomatic therapy. Thus, the treatment of patients with dyschezia depends largely on the primary cause. For example, in the case of extensive recto-vaginal endometriosis, invasive procedures are available to eliminate the cause. Surgery should always be considered in this case to provide long-term relief. Surgery is also usually the treatment of choice for patients with Hirschsprung’s disease. Symptomatic treatment options usually boil down to biofeedback for patients with dyschezia, regardless of disease. At least short-term improvements of the symptoms can be achieved by this method. In the past, the experimental administration of laxatives was also tried for symptomatic therapy. However, this approach achieved much less improvement than the biofeedback method.
Outlook and prognosis
The prognosis of dyschezia depends on the causative condition. If the symptoms are tied to the female menstrual cycle, there is always spontaneous recovery within a few days. With the absence of menstruation in the menopause, a permanent cure and freedom from symptoms is achieved in the further course. The prognosis is less favorable in the case of chronic or psychological causes. Without therapy, the symptoms often persist for several years and are usually changeable and fluctuate in intensity. If therapy is sought for an underlying mental illness, the healing process takes several months to years.In many cases, relief of symptoms is observed as soon as the patient is willing to work on his emotional issues and bring about changes. Supportively, the affected person can have a positive influence on his health development through an optimal and healthy food intake. Harmful substances such as alcohol and nicotine should be avoided, as well as particularly fatty or stressful foods. In the case of conditions such as hemorrhoids or prolapse, dyschezia has a good prognosis after medical treatment or surgery. There is a subsiding of the symptoms after the wound healing process and the bowel activity can start its natural activity.
Prevention
Dyschezia can be prevented only in moderation. For example, one preventive measure is to defecate as quickly as possible after the onset of the urge to defecate. In addition, all preventive measures for the prophylaxis of primary diseases such as hemorrhoids and rectal prolapse should be observed to avoid developing dyschezia in the future.
Follow-up
In the case of dyschezia, the affected person is primarily dependent on a comprehensive and, above all, an early diagnosis, so that there is no further worsening of the symptoms or other complications. As a rule, self-healing cannot occur, so that treatment by a physician is indispensable for this disease. Whether the disease can be easily treated depends mostly very much on the exact underlying disease, so that about it usually no general prediction can be made. As a rule, dyschezia can be treated with the help of laxatives. However, a maximum dose should be observed. If the symptoms of dyschezia continue to occur, a doctor should be consulted in any case, otherwise damage may be caused by long-term use of the laxatives. In some cases, surgical interventions may be necessary to permanently alleviate the symptoms. After such an operation, the affected person is in any case dependent on bed rest. They should refrain from exertion or other physical and stressful activities. In most cases, dyschezia does not negatively affect the life expectancy of the affected person.
Here’s what you can do yourself
Dyschezia can be due to highly diverse causes. What the patient himself can do to improve his condition depends on the trigger of the disorder. Anyone who discovers the first signs of defecation disorder in himself should in any case immediately consult a doctor. Under no circumstances should the condition be self-medicated, as significant complications may develop in the event of inadequate therapy. If the dyschezia is due to irritable bowel syndrome, food intolerance may be the trigger. The patient should then have an allergy test done and also keep a food diary. Over a period of several weeks, it can thus be determined whether the irritable bowel attacks are in temporal proximity to the consumption of certain foods. If the irritable bowel syndrome and the resulting dyschezia are accompanied alternately by diarrhea and constipation, this can also be positively influenced by an appropriate diet. While the patient is suffering from constipation, fiber-rich, slightly laxative food should be ingested. This includes, for example, psyllium or dried fruit. If the patient suffers from diarrhea, on the other hand, a lightly constipating diet is indicated. This effect can be achieved very well with bananas. Dyschezia is often accompanied by flatulence and acute cramps. In these cases, a hot water bottle placed on the abdomen can help. A gentle, circular massage around the belly button also provides relief for many patients.