VIDEO: Examining pelvic floor dysfunction as a cause of constipation

Editor’s note: This is a previously posted video, and the below is an automatically generated transcript to be used for informational purposes. Please notify editor@healio.com if there are concerns regarding accuracy of the transcription.

You know you asked earlier about the different types of constipation. We've talked about chronic idiopathic constipation, IBS-C and opioid-induced constipation. But there's one other cause of constipation that can overlap with all of these three conditions or the condition by itself, which is pelvic floor dysfunction, or dyssynergic defecation, anismus, goes by different names, but essentially, it's an obstructive defecatory dysfunction, meaning the anus sphincter or the puborectalis is not relaxing appropriately or there's poor coordination between the abdominal rectal contractions and relaxation of the pelvic floor muscles. So, in essence, the stool gets stuck in the rectum because it's unable to be evacuated. You can do complex testing like an anorectal manometry but you can diagnose pelvic floor dysfunction simply with the history. Usually patients will describe feeling the urge to go but then nothing happens or they strain, or they spend 30 to 60 minutes in the toilet and a little bit comes out or they feel incomplete evacuation. So those are some of the common symptoms that are described by doing a rectal exam and asking patients to bear down, you can feel for relaxation of the puborectalis and if you put one hand on the abdomen, you can feel for appropriate contraction of the abdominal muscles. In patients where you're not sure that there's pelvic floor dysfunction on exam, you can do a balloon expulsion test or a full anorectal manometry. The other times you would think about pelvic floor dysfunction are in patients with CIC, IBS-C, OI-C, who you treat but they're not responding to therapy. So, you put them on whatever therapies are available and they're not responding to it. And rather than cycling all the therapies, think about, could there be a component of pelvic floor dysfunction that can be treated? And when you think about any cause of constipation, they're generally chronic conditions but pelvic floor dysfunction there's actually a cure for if you dare use the word, through pelvic floor physical therapy. So, doing pelvic floor physical therapy and biofeedback, between 70 and 90% of patients have significant improvement in potentially cure of their defecatory symptoms. So, if the constipation is purely due to a pelvic floor dysfunction, you can, in theory, cure it and that you have a durable response. Unlike other medical therapies, when you stop the therapy, patients regress and return to their baseline symptoms.