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Dyssynergic Defecation and Pelvic Floor Therapy for Constipation: What You Need to Know

by Valerie Polley | Feb 13, 2023 | 2 comments

Have you made changes to your diet but are still struggling to go? If so, you may have a condition called dyssynergic defecation. Dyssynergic defecation is a condition where your pelvic floor does not properly coordinate the nerves and muscles, making it difficult to have a bowel movement. 

Luckily, pelvic floor therapy for constipation is an effective method of treating dyssynergic defecation. To learn more about dyssynergic defecation and pelvic floor therapy for constipation, read on.

What is Dyssynergic Defecation?

The pelvic floor is a complex system of nerves and muscles located at the lower part of the abdomen. It supports the pelvic organs such as the bowel, uterus, and bladder. One of its most important functions is helping us have regular bowel movements.

To encourage a bowel movement, the muscles and nerves of the pelvic floor must move in a coordinated manner. With dyssynergic defecation, there is a problem with how the muscles and nerves in the pelvic floor function, and they do not relax properly to allow a bowel movement.  When stool isn’t passed regularly, it becomes hardened and can feel stuck in your bowels, making it more difficult to pass.

 

What are the Symptoms of Dyssynergic Defecation?

Symptoms of dyssynergic defecation are similar to those of severe constipation, and include:

  • Having fewer than three bowel movements per week
  • Excessive straining to have a bowel movement
  • Feelings of incomplete evacuation (like there is still some stool left in the rectum after you have a bowel movement).
  • Hard, painful stools
  • The need to use your fingers to remove the stool
  • Bloated stomach
  • Stomach pain
  • Anal pain

While it can feel embarrassing to discuss these symptoms with your healthcare provider, providing an honest report of your symptoms is important for helping receive a diagnosis and coming up with an effective treatment plan.

How Common is Dyssynergic Defecation?

According to the Cleveland Clinic, it’s estimated that 15% to 25% of all chronic constipation cases are caused by dyssynergic defecation. They also estimate that chronic constipation affects between 10% and 20% of people worldwide and is about twice as common in people assigned female at birth.

 

What Causes Dyssynergic Defecation?

In a study of 118 people with dyssynergic defecation, researchers found that about one-third of people developed it during childhood. Another one-third developed it after an event such as pregnancy, trauma, or back injury. As many as 40% of people with dyssynergic defecation developed it for unknown reasons.

Dyssynergic defecation is a functional bowel disorder, meaning that the exact cause is unknown.

 

How is Dyssynergic Defecation Diagnosed?

The first step in diagnosing dyssynergic defecation is excluding other underlying disorders. Slow passage of waste through the colon may exist in up to two-thirds of people with dyssynergic defecation, so a test to assess colonic transit can be beneficial.

Here are some other tests and procedures used to diagnose dyssynergic defecation:

 

Digital Rectal Examination

A digital rectal examination is a medical test during which your doctor will insert a gloved, lubricated finger into your rectum to check for any abnormalities.

During the test, you may be asked to “bear down” as if you’re trying to have a bowel movement. This will allow your doctor to feel how the muscles move. If the muscles are moving abnormally, it may indicate dyssynergic defecation.

 

Anorectal Manometry

An anorectal manometry test measures how well the rectum and anal sphincter work. During the test, a small, flexible tube called a catheter with a balloon on the end is inserted into the rectum through the anus.

As the balloon is gradually inflated, it mimics the feeling of stool in the rectum. A machine connected to the tube measures the contractions and relaxations of the rectum and anal sphincter. By assessing these contractions and relaxations, your doctor can determine whether there is a discoordination of your pelvic floor muscles.

 

Balloon Expulsion Test

During the balloon expulsion test, a small balloon filled with warm water is placed in the rectum. Once the balloon is placed, you will move to a private room and be asked to push the balloon out.

Normally, a person can push the balloon out of their rectum in under one minute. If someone has dyssynergic defecation, it will often take longer than one minute to push out the balloon.

 

Defecography

During defecography, X-rays are used to record moving images of barium (a semi-solid paste) as it passes through the rectum. The barium simulates the passing of a soft stool, and the test can provide valuable information about structural changes that may be responsible for constipation.

 

Pelvic Floor Therapy for Constipation      

Once you’ve received a diagnosis of dyssynergic defecation, it’s time to develop a treatment plan. The most common type of pelvic floor therapy for constipation is called biofeedback therapy or biofeedback training.

Biofeedback training teaches you how to properly engage and relax your pelvic floor muscles and is considered the best treatment for dyssynergic defecation. This technique, which can be completed by a trained pelvic floor physical therapist, is used to correct the coordination of the abdominal and pelvic muscles during evacuation and to improve the perception of stool in the rectum.

 

What to Expect During a Biofeedback Training Session

During a biofeedback training session, your pelvic floor physical therapist will insert a probe into your anal sphincter. They will then place sticky pads on your abdomen. This will allow them to detect the movement of the muscles as you simulate having a bowel movement.

As you simulate having a bowel movement, you will receive visual or verbal feedback about what the muscles in your abdominal wall and anal sphincter are doing during a bowel movement. The pelvic floor physical therapist will have you do breathing exercises and muscle strengthening and relaxation exercises. This is what retrains the movement and coordination of your pelvic floor muscles.

According to research, the best protocol for biofeedback therapy includes doing 30–60-minute sessions one to two weeks apart for four to six sessions. After this protocol is completed, reinforcement sessions should be completed at six weeks, three months, six months, and twelve months.

 

How to Find a Pelvic Floor Physical Therapist

The best way to find a pelvic floor physical therapist is to get a referral from another healthcare provider (such as your dietitian or family doctor) or by doing a Google search yourself.

Here are a few tips that can help you find a pelvic floor physical therapist:

  • Search “pelvic floor physical therapist near me” to find therapists in your area.
  • Look at prospective clinics’ websites. This will often answer commonly asked questions, explain what to expect at your first visit, and provide information about the therapist’s credentials and experience.
  • If you have questions that are not answered by the clinic’s website, reach out to the clinic by phone or email. They should be able to put you in touch with a therapist who can answer your questions.
  • Find out if pelvic floor physical therapy is covered by your insurance provider.
  • Don’t be afraid to “shop around.” Pelvic floor physical therapy is intimate care, and it’s important that you find a provider that makes you feel comfortable.

 

Final Thoughts

Dyssynergic defecation is a common cause of chronic constipation. Luckily, pelvic floor therapy for constipation is an effective treatment.

If you’re struggling with constipation, it’s important to ensure other modifiable factors are well-managed in conjunction with using pelvic floor therapy as a treatment. This includes getting enough fluid and fiber through your diet. If you’re struggling to make dietary changes to manage chronic constipation, a registered dietitian can help.

At Blue Tree Nutrition, our dietitian has experience working with dietary treatments for constipation and can also help you connect with a pelvic floor therapist. Click here to get in touch and book an appointment today.

"Processed food" has become a catch-all term for foods we're told to avoid, but food processing isn't automatically a bad thing.

Technically, many foods you probably enjoy regularly are processed. Frozen vegetables, canned beans, yogurt, nut butter, and whole-grain bread have all been changed from their original state in some way.

So when research links processed foods to certain health concerns, it's important to understand what kind of processing we're talking about.

Much of the recent research has focused specifically on ultra-processed foods (UPFs). Diets containing large amounts of these foods have been linked to a range of negative health outcomes, including digestive and metabolic health issues, inflammation, and heart disease.

This article will review what we know so far and give you tips for including more whole foods in your diet.

Processed vs. Ultra-Processed Foods: Understanding the Difference

In food and nutrition research, a system called the NOVA classification is often used to group foods according to the type and extent of processing they undergo.

Minimally processed foods include fruits, vegetables, eggs, milk, and plain grains that may have been washed, frozen, pasteurized, dried, or otherwise prepared without significantly changing them from their original state.

Processed foods are generally made by adding ingredients such as salt, sugar, or oil. Examples include canned vegetables, cheeses, or freshly made breads.

Finally, ultra-processed foods are industrial formulations containing ingredients or additives not typically used in home cooking. Examples include many sodas, packaged snacks, instant noodles, candies, and some ready-to-eat meals.

This distinction is important because simply avoiding all processed foods would mean missing out on many convenient and nutritious options (such as canned beans and vegetables).

It's also important to recognize that there's considerable variation among foods categorized as UPFs. For example, a packaged whole-grain bread and a soda may both meet the criteria for ultra-processing under the NOVA classification, despite having very different nutritional profiles. 

Instead of deciding not to eat a food simply because it's processed, it can be more useful to look at the bigger picture and consider what nutrients the food provides and how it fits into your overall diet.

How Can Ultra-Processed Foods Affect Digestion?

While we're still uncovering exactly how UPFs affect the digestive system, one possibility is that they lack fiber.

Some diets high in UPFs are lower in naturally fiber-rich foods like fruits, vegetables, whole grains, beans, lentils, nuts, and seeds. You probably know fiber is important for staying regular, but certain types of fiber (known as prebiotics) act as food for the beneficial bacteria living in your gut. A diet lower in fiber may therefore affect both digestion and the health of your gut microbiome. 

There's also research currently examining the effects of common additives found in UPFs, such as certain emulsifiers and artificial sweeteners. However, most of the research linking these additives to negative effects on the gut microbiome and intestinal barrier has been conducted in vitro (test tube) or animal studies, so more research is needed before we can confirm whether these additives are harmful in humans.

Finally, some studies have found links between UPF intake and certain gut conditions. For example, a large systematic review and meta-analysis found that higher UPF consumption was associated with an increased risk of developing Crohn's disease.

However, there's still a lot we don't know about how UPFs impact gut health, and more research in humans is needed to understand which food components or other dietary factors may be responsible.

UPFs and Inflammation

Chronic, low-grade inflammation has been linked to the development of several chronic diseases, prompting researchers to investigate whether diets high in UPFs could contribute to inflammation.

Here are a few possible explanations:

  • A diet high in UPFs may contain fewer foods rich in fiber, vitamins, minerals, and phytochemicals, which are associated with better overall diet quality.
  • A diet high in UPFs can also contribute significant amounts of refined carbohydrates, saturated and trans fats, sodium, or added sugars.
  • Certain ingredients in UPFs may alter the gut microbiome and promote gut inflammation.

However, much of the evidence connecting UPF intake with inflammation and chronic disease is observational. Studies like these can identify patterns, but they can't always tell us whether UPFs specifically are responsible or whether other differences in diet and lifestyle contribute to the association.

UPFs and Overall Health

The research on UPFs becomes more conclusive when we zoom out to consider overall health.

A 2024 umbrella review published in The BMJ found that higher exposure to UPFs was linked with increased risk across several health outcomes, with some of the strongest evidence involving heart disease, type 2 diabetes, mental health outcomes, and overall death rates.

However, it's important to note that the quality of the studies included in the review varied considerably. Only four of the 45 studies they reviewed received a moderate-quality rating; most were rated low or very low quality.

That said, there is some experimental evidence to consider. A small but well-controlled study of 20 adults found that those eating UPFs consumed an average of 500 additional calories per day and gained about 2 pounds. They lost a similar amount of weight when eating the minimally processed diet. The study showed that something about the UPF dietary pattern encouraged greater calorie intake, but it couldn't identify exactly which UPF component was responsible.

Do You Need to Stop Eating UPFs?

UPFs can provide valuable nutrients, and all foods classified as UPFs are not nutritionally identical. Instead of trying to eliminate all foods that qualify as UPFs, consider your overall dietary pattern. For example:

  • Are you including fruits and vegetables throughout the day (fresh, frozen, or canned)
  • Are you choosing whole grains and other fiber-rich foods regularly?
  • Do you include beans, lentils, nuts, and seeds in your diet?
  • Do you compare packaged foods based on what nutrients they actually provide rather than assuming that processing alone determines their nutritional value?
  • Do you use convenience foods like canned beans and vegetables to make balanced meals easier, rather than feeling overwhelmed trying to prepare everything from scratch?

If UPFs currently make up a large portion of your diet, you don't need to overhaul everything overnight. Instead, try adding more minimally processed, nutrient-dense foods alongside the foods you already enjoy.

The Bottom Line

Food processing exists on a spectrum, and processed doesn't automatically mean unhealthy.

Research suggests that diets high in UPFs are associated with several health concerns, but researchers are still working to determine why these associations exist and whether all foods classified as UPFs carry the same risks.

Rather than fearing individual foods, focus on your overall dietary pattern. A diet built around a variety of fiber-rich plant foods, adequate protein, and nutrient-dense choices can still leave room for the occasional UPFs.

If you need help incorporating more whole foods into your diet, a dietitian can help. Click here to book an appointment with us at Blue Tree Nutrition.

 

2 Comments

  1. Alicia
    Alicia on October 3, 2023 at 5:52 pm

    I have chronic constipation, low motility, Ehlers Danlos syndrome and am working with a GI at UCLA who has recommended a manometry test and biofeedback. Am interested in the biofeedback and what it involves and if it’s too late for me brain and body to relearn at age 71.

    Reply
    • Valerie Polley
      Valerie Polley on October 4, 2023 at 9:56 am

      Alicia,
      It is worth trying biofeedback therapy with a physical therapist trained in this area. I have had clients in their 80’s meet with physical therapists trained in pelvic floor therapy for constipation and have results.

      Reply

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Hello, I am

Valerie

My name is Valerie Polley. I am a Indianapolis-based registered dietitian and owner of Blue Tree Nutrition. I consult with clients both local and far away.
I have a bachelor’s degree in nutrition from Purdue University and I have been practicing for 20 years.
I thoroughly enjoy helping clients through their gut health journey. I see a range of GI issues including, but not limited to celiac disease, IBS and SIBO. I also specialize in the FODMAP elimination diet.

CONTACT ME