Synonyms for anismus or Related words with anismus
Examples of "anismus"
Others inappropriately equate obstructed defecation with
is a type of obstructed defecation, obstructed defecation has many other possible causes other than
Physical examination can rule out
(by identifying another cause) but is not sufficient to diagnose
is classified as a functional defecation disorder. It is also a type of rectal outlet obstruction (a functional outlet obstruction). Where
causes constipation, it is an example of functional constipation. Some authors describe an "obstructed defecation syndrome", of which
is a cause.
occurs in the context of intractable encopresis (as it often does), resolution of
may be insufficient to resolve encopresis. For this reason, and because biofeedback training is invasive, expensive, and labor-intensive, biofeedback training is not recommended for treatment of encopresis with
include biofeedback retraining, botox injections, and surgical resection.
sometimes occurs together with other conditions that limit (see contraindication) the choice of treatments. Thus, thorough evaluation is recommended prior to treatment.
Constipation also has neurological causes, including
, descending perineum syndrome, and Hirschsprung's disease. In infants, Hirschsprung's disease is the most common medical disorder associated with constipation.
occurs in a small minority of persons with chronic constipation or obstructed defecation.
could be thought of as the patient "forgetting" how to push correctly, i.e. straining against a contracted pelvic floor, instead of increasing abdominal cavity pressures and lowering pelvic cavity pressures. It may be that this scenario develops due to stress. For example, one study reported that
was strongly associated with sexual abuse in women. One paper stated that events such as pregnancy, childbirth, gynaecological descent or neurogenic disturbances of the brain-bowel axis could lead to a "functional obstructed defecation syndrome" (including
may develop in persons with extrapyramidal motor disturbance due to Parkinson's disease. This represents a type of focal dystonia.
may also occur with anorectal malformation, rectocele, rectal prolapse and rectal ulcer.
Biofeedback training for treatment of
is highly effective and considered the gold standard therapy by many.
(or dyssynergic defecation) refers to the failure of the normal relaxation of pelvic floor muscles during attempted defecation.
can occur in both children and adults, and in both men and women (although it is more common in women). It can be caused by physical defects or it can occur for other reasons or unknown reasons.
that has a behavioral cause could be viewed as having similarities with parcopresis, or psychogenic fecal retention.
Another specific example is functional constipation, which may have psychological or psychiatric causes. However, one type of apparently functional constipation,
, may have a neurological (physical) basis.
It has been suggested that some patients may be embarrassed by this procedure, which give findings of abnormal defecation. For example, the patient may not be able to relax under the conditions, leading to relaxation failure of puborectalis and false positive diagnosis of
. It has also been reported that there is a high false positive rate of
diagnosis with anorectal manometry for similar reasons.
is a paradoxical contraction of the external anal sphincter, when the intent is relaxation, which can result in obstructed defecation and constipation. Abnormal function of this muscle is also seen in anorectal malformation and after certain surgeries, including coccygectomy.
Disorders of the posterior pelvic floor include rectal prolapse, rectocele, perineal hernia, and a number of functional disorders including
. Constipation due to any of these disorders is called "functional constipation" and is identifiable by clinical diagnostic criteria.
Initial steps to alleviate
include dietary adjustments and simple adjustments when attempting to defecate. Supplementation with a bulking agent such as psyllium 3500 mg per day will make stool more bulky, which decreases the effort required to evacuate. Similarly, exercise and adequate hydration may help to optimise stool form. The anorectal angle has been shown to flatten out when in a squatting position, and is thus recommended for patients with functional outlet obstruction like
. If the patient is unable to assume a squatting postures due to mobility issues, a low stool can be used to raise the feet when sitting, which effectively achieves a similar position.
Paradoxical anal contraction during attempted defecation in constipated patients was first described in a paper in 1985, when the term
was first used. The researchers drew analogies to a condition called vaginismus, which involves paroxysmal (sudden and short lasting) contraction of pubococcygeus (another muscle of the pelvic floor). These researchers felt that this condition was a spastic dysfunction of the anus, analogous to ‘vaginismus’. However, the term
implies a psychogenic etiology, which is not true although psychological dysfunction has been described in these patients. Hence:
Some authors have commented that the "puborectalis paradox" and "spastic pelvic floor" concepts have no objective data to support their validity. They state that "new evidence showing that defecation is an integrated process of colonic and rectal emptying suggests that
may be much more complex than a simple disorder of the pelvic floor muscles."
Obstructed defecation has many causes, so the management in any individual case is specific to the cause of the symptom. For rectal internal intususception treatment is surgical, either STARR or rectopexy. For rectocele STARR or mesh implantation. For
/ pelvic floor dessynergia: biofeedback exercise.
The assumed mechanism of obstructed defecation is by disruption to the rectum and anal canal's ability to contract and fully evacuate rectal contents. The intussusceptum itself may mechanically obstruct the rectoanal lumen, creating a blockage that straining,
and colonic dysmotility exacerbate.
More effort is required because of concomitant
, or non-relaxation/paradoxical contraction of puborectalis (which should normally relax during defecation). The increased pressure forces the anterior rectal lining against the contracted puborectalis and frequently the lining prolapses into the anal canal during straining and then returns to its normal position afterwards.
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