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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.

Our gut microbiome (the community of trillions of microbes that live in our gut) plays a key role in maintaining metabolic and immune health. Gut dysbiosis occurs when the composition and diversity of our gut microbiome shift. This could include overgrowth of harmful bacteria or a decrease in beneficial bacteria. Gut dysbiosis has been linked to a wide range of negative health outcomes, including increased levels of inflammation and changes in metabolism.

Many people switch to non-nutritive sweeteners like sucralose, aspartame, and stevia for health reasons, and for decades, we've believed that they pass through our bodies without affecting us. But emerging research shows that these compounds interact directly with our gut microbiome and may have potential negative effects on our health. 

This article will review what we currently know about the relationship between non-nutritive sweeteners (including artificial sweeteners and calorie-free natural sweeteners) and the gut microbiome, plus practical advice for navigating sweeteners.

Sucralose

Sucralose (Splenda) is an artificial sweetener commonly used in baked goods, gums, and sugar-free beverages and is approximately 600 times sweeter than sucrose (table sugar). However, recent research has linked it to adverse health effects such as systemic inflammation, metabolic disease, and gut dysbiosis. For example, a 2022 study found that sucralose consumption increased harmful bacteria and reduced beneficial bacteria, which was associated with changes in insulin and glucose levels.

Additionally, a 2025 randomized controlled trial examining the effects of replacing added sugars with sucralose found that people with type 2 diabetes who consumed sucralose experienced reductions in both alpha diversity (the number and types of species present in a single person) and beta diversity (differences in microbial composition between people). Interestingly, the people with overweight and obesity without type 2 diabetes did not experience the same changes.

Overall, animal studies and limited human studies suggest that sucralose may trigger intestinal inflammation, likely through its effects on the gut microbiome. However, since most of the evidence we have comes from test tube or animal studies, these results should be interpreted cautiously.

Aspartame

Aspartame is another commonly used artificial sweetener that is about 200 times as sweet as sucrose. While it does contain some calories, because you don't need much of it to reach the same sweetness levels as sucrose, these calories are negligible.

Like sucralose, most of the research into the gut effects of aspartame has been done in animals. However, we do have some very small human studies. A 2022 randomized controlled trial (RCT) involving 20 healthy adults found that participants taking aspartame showed changes in both probiotic (beneficial) and pathogenic (harmful) bacteria, but the changes were specific to each individual. 

Why the differences? It's likely due to the "responder vs. non-responder" phenomenon. We all have differences in our "baseline" microbiome. While certain bacterial species are common in healthy populations, our microbiome is as unique as a fingerprint. Whether an artificial sweetener has positive or negative effects on our microbiome may depend on which species are already present in our gut, as well as on our habitual diet. This difference in responses makes it very challenging to draw firm conclusions about whether artificial sweeteners are harmful.

Stevia

Many people choose stevia because it's a "natural" zero-calorie sweetener. Studies have shown mixed results regarding the effects of stevia on the gut microbiome. For example, while some in vitro (test tube) and in vivo (animal) studies have reported potentially harmful effects of stevia on the gut microbiome, others have found no impact, and some even reported beneficial effects through inhibition of inflammatory pathways.

Additionally, a 2024 human study found that stevia had no significant effect on the gut microbiome. This highlights the importance of not forming conclusions based solely on test tube and animal studies. Overall, it appears that stevia is a potentially less-harmful alternative to artificial sweeteners like sucralose and aspartame.

Practical Advice for Navigating Sweeteners

Since the research on artificial sweeteners is still evolving, the decision to include or avoid them comes down to personal preference. Here are some tips for including them in your diet in moderation:

  • Try gradually reducing the amount you use: If you typically use two packets of sweetener in your coffee or tea, try gradually reducing to one packet. Our taste buds are highly adaptable, and you may find that one packet is sweet enough once you get used to it.
  • Check your labels: Low- or no-calorie sweeteners (such as sucralose, aspartame, and sugar alcohols like erythritol) are often hidden in low-sugar foods like protein bars, yogurt, and diet sodas. Awareness is the first step to reducing your intake.
  • Rotate your sources: If you do use artificial sweeteners, try switching up the types you use. Since different sweeteners may affect your gut microbiome in different ways, this may reduce the concentrated impact on your gut.
  • Switch to stevia: While animal and test-tube studies show mixed findings, human research indicates that stevia has a limited effect on the gut microbiome, making it a better choice for people seeking to support their gut health.

Another way to support your gut if you regularly use artificial sweeteners is to rebuild gut diversity with fiber and fermented foods, while focusing on whole-food sweeteners.

  • High fiber prebiotic foods (like legumes, whole grains, garlic, onions, asparagus, and under-ripe bananas) act as "fuel" for your healthy gut microbes. Aim to include a variety of these foods in your diet to support the microbes already in your gut.
  • Add fermented foods, like unpasteurized sauerkraut and kimchi, kefir, or kombucha, to your diet. Some fermented foods contain live, beneficial bacterial cultures, while others are rich in "postbiotics" (beneficial compounds like short-chain fatty acids, which are produced when bacteria break down prebiotics).
  • Try using whole-food sweeteners instead of artificial ones. For example, sweeten plain yogurt with vanilla extract and berries or add dates to smoothies or homemade energy bites.

Final Thoughts

Emerging research suggests that certain low- or no-calorie sweeteners, including sucralose and aspartame, may affect the gut microbiome, whereas stevia appears to have a less negative effect. While individual responses can vary with a person's unique baseline microbiome, certain artificial sweeteners may increase inflammation or reduce gut microbiome diversity.

If you need personalized support navigating sweeteners or supporting your gut health, Blue Tree Nutrition can help. Click here to get in touch!

 

 

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