Intestinal Immune System
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Dyschezia, also known as primary constipation, is a condition characterized by difficulty in expelling feces due to a functional or morphological alteration of the rectum. This condition does not affect the motility of the upper sections of the colon, and the transit of feces is slowed down only at the rectal level. It is sometimes referred to as constipation due to obstructed defecation. This post aims to explore the causes, symptoms, and treatment options for dyschezia.
Functional dyschezia often arises in the absence of anatomical alterations or underlying diseases. It is frequently linked to an incorrect lifestyle, such as a sedentary lifestyle, which can lead to weakness of the abdominal muscles and pelvic floor. This weakness compromises the efficiency of the abdominal press during defecation.
Additionally, the habit of postponing defecation can result in the accumulation of feces in the rectal ampulla, gradually making it less sensitive to the stimuli that originate from the state of distension of its wall. Consequently, larger quantities of feces are needed to distend the ampulla and trigger the stimulus to defecate.
Certain muscle weaknesses or lack of coordination can also cause dyschezia. For instance, if the puborectalis muscle, which is involved in defecation, contracts instead of relaxing, it can lead to problems with obstructed defecation.
Dyschezia can be a symptom of many diseases, both common and rare. Among the common causes are:
Rare causes of dyschezia can include:
It's important to note that dyschezia can also be a symptom of other diseases not listed here.
Individuals with dyschezia often experience painful defecation and a sensation of a foreign body in the rectum. Voluntary inhibition of defecation due to pain can lead to a vicious cycle where patients may lose the natural ability to contract and release certain muscles during the act of defecation.
Chronic constipation can traumatize the rectal mucosa, potentially causing a solitary rectal ulcer. This ulcer can lead to rectorrhagia and mucorrhoea, which involve the loss of blood of rectal origin and/or mucus from the anus. In some cases, the weakening of the muscles and ligaments that support the rectum can lead to rectal prolapse.
The diagnosis of dyschezia often involves anorectal manometry, a test that evaluates the strength of the muscles involved in the continence of the rectal ampulla and those responsible for the physiological evacuation of feces. This test also assesses how the rectum responds to the evacuation stimulus.
Another diagnostic tool is the balloon expulsion test. In this test, a balloon is placed in the patient's rectum and inflated with air. The patient is then asked to expel the balloon. If they are unable to do so, this indicates a pelvic floor dysfunction.
Treatment for dyschezia often involves addressing any underlying pathological causes and re-educating the bowel through biofeedback or sphincter re-education. This involves a series of exercises performed under medical supervision, which help the patient learn the mechanism of defecation in real time.
Electro-stimulation is another treatment option. It involves inducing the contraction of muscle fibers through a mild electric current applied via one or more electrodes inserted into the anal canal.
In addition, regular physical activity and a diet rich in water and soluble fiber can be beneficial. It may also be helpful for patients to establish a regular time for bowel evacuation.