anismus

Anismus: A Disorder of Pelvic Floor Muscles

Anismus, also known as dyssynergic defecation or anal sphincter dyssynergia, is a condition where the pelvic floor muscles fail to relax during attempted defecation [4]. This can lead to difficulties in passing stool and may cause symptoms such as pain, tenderness, or discomfort during bowel movements [8].

Characteristics of Anismus

Anismus is characterized by the failure of relaxation of the puborectalis muscle and the external anal sphincter muscle, or a paradoxical contraction of both muscles during straining to defecate [5]. This uncoordinated relaxation can cause the pelvic floor muscles to spasm, leading to constipation and other bowel-related problems.

Causes and Effects

Anismus has been recognized as a cause of chronic constipation [5] and may also affect urination. The condition is often described as a functional disorder, where the voluntary striated anal sphincter muscle contracts instead of relaxing during attempted defecation [7].

Symptoms and Signs

The symptoms of anismus include pain, tenderness, or discomfort during bowel movements or anal penetration [8]. Physical signs may include perineal and/or pelvic floor muscle elevation with sustained contraction.

References

• [4] Anismus is a condition where the pelvic floor muscles fail to relax during attempted defecation.
• [5] Failure of relaxation of the puborectalis muscle and the external anal sphincter muscle or a paradoxical contraction of both during straining to defecate can cause chronic constipation.
• [7] Anismus is best described as a functional disorder in which uncoordinated relaxation of the voluntary striated anal sphincter muscle occurs during attempted defecation.
• [8] Symptoms of anismus include pain, tenderness, or discomfort during bowel movements or anal penetration.

Anismus, also known as dyssynergic defecation, is a condition where the muscles in the pelvic floor do not function properly, leading to difficulty with bowel movements.

Common symptoms of anismus include:

• Difficulty initiating defecation [3]
• Incomplete evacuation of stool [3][4]
• Straining excessively during defecation [5][6]
• Feeling of blockage or resistance to passing stool [4]
• Constipation and hard or lumpy stools [5][6]

Individuals with anismus may also experience a feeling of incomplete bowel movement, which can be painful and lead to obstructive constipation. Other problems associated with anismus include rectal hyposensitivity, where the individual loses sensation in their rectum.

It's essential to note that these symptoms can vary from person to person, and not everyone will experience all of them. If you're experiencing any of these symptoms, it's crucial to consult a healthcare professional for proper diagnosis and treatment.

References: [1] - Not applicable [2] - Not applicable [3] - Context 3: "The clinical findings in patients with anismus include an inability to initiate defecation, incomplete evacuation, a history of manual disimpaction, the..." [4] - Context 4: "People with anismus often get a sensation of blockage or resistance to passing stool. This can be painful and lead to obstructive constipation. Other problems..." [5] - Context 5: "1. Difficulty with Bowel Movements: Individuals may experience constipation and find it challenging to pass stool, often straining excessively during defecation..." [6] - Context 6: "Apr 28, 2023 — Symptoms · fewer than three bowel movements per week · lengthy, excessive straining · hard or lumpy stools · feeling of having incomplete bowel..."

Diagnostic Tests for Anismus

Anismus, also known as dyssynergic defecation, is a condition where there is a lack of coordination between the muscles in the rectum and anus during bowel movements. Diagnosing anismus can be challenging, but several diagnostic tests can help confirm the condition.

• Anorectal Manometry (ARM): This test is considered the "gold standard" for diagnosing anismus. ARM measures the pressure in the rectum and anal sphincter muscles to determine if there is a coordination problem during bowel movements [15].
• Pelvic Floor Exam: A pelvic floor exam is an essential part of the diagnosis of anismus. This exam assesses the strength and function of the muscles in the pelvis, including the puborectalis muscle [15].
• Anorectal Manometry with Balloon Expulsion Test: This test combines ARM with a balloon expulsion test to evaluate the coordination between the rectal and anal sphincter muscles during bowel movements [6].
• Electromyography (EMG): EMG measures the electrical activity of the muscles in the rectum and anus. Abnormal EMG readings can indicate anismus [16].
• Pudendal Nerve Terminal Motor Latency Electromyography: This test evaluates the function of the pudendal nerve, which controls the muscles involved in bowel movements [6].
• Defecography: Defecography is a type of imaging test that uses X-rays or MRI to visualize the movement of stool through the rectum and anus. Abnormal defecography results can indicate anismus [5].

These diagnostic tests are essential for accurately diagnosing anismus and developing effective treatment plans.

References:

[15] The diagnosis of Anismus is typically confirmed using anorectal manometry (ARM), which measures the pressure in the rectum and anal sphincter muscles. ARM is considered as the “gold standard” diagnostic test for Anismus. [6] If further study would be able to suggest a way to reduce the number of tests required, it would likely involve combining multiple tests such as anorectal manometry with balloon expulsion test, defecography, or marker retention with colonic transit study. [5] Defecography is a type of imaging test that uses X-rays or MRI to visualize the movement of stool through the rectum and anus. Abnormal defecography results can indicate anismus.

Treatment Options for Anismus

Anismus, also known as dyssynergic defecation, can be treated using various methods, including drug treatment.

• Botox injections: Botox injections into the puborectalis muscle, which supports the rectum, have been shown to be effective in treating anismus. According to a study [8], after Botox injection and subsequent biofeedback, 77% of patients had an initial symptom improvement, and 74% had a durable improvement over 8 months of follow-up.
• Biofeedback therapy: Biofeedback therapy is also used to treat anismus. It involves the use of instruments to provide feedback on the pelvic floor muscles, helping patients learn better bowel habits [2][7].
• Other treatments: Other forms of treatment for anismus include dietary adjustments, such as dietary fiber supplementation, and surgical resectioning of the puborectalis muscle.

It's worth noting that while drug treatment can be effective, it is often used in conjunction with other therapies, such as biofeedback or physical therapy, to achieve optimal results.

Differential Diagnosis of Anismus

Anismus, also known as dyssynergic defec