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Anismus
 
 
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Anismus (also known as spastic pelvic floor syndrome, anal sphincter dyssynergia, pelvic floor dyssynergia and dyssynergic defecation) is a malfunction of the external anal sphincter and puborectalis muscle
Puborectalis muscle

The fibers which form a sling for the rectum are named the Puborectalis or Sphincter recti.They arise from the lower part of the symphysis pubis, and from the superior fascia of the urogenital diaphragm....
 during defecation
Defecation

Defecation is the final act of digestion by which organisms eliminate solid, semisolid or liquid waste material from the digestive tract via the anus....
. Normal defecation involves relaxation of both of these muscles. Malfunction involves their failure to relax or their paradoxical increased contraction
Contraction

Contraction may refer to:* Contraction , a contraction during childbirth * Contraction , a word formed from two or more individual words.* Syncope , the loss or reduction of sounds within a word....
. Anismus is a form of obstructed defecation and can cause constipation
Constipation

Constipation, costiveness, or irregularity, is a condition of the digestive system in which a person experiences hard feces that are difficult to expel....
.






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Anismus (also known as spastic pelvic floor syndrome, anal sphincter dyssynergia, pelvic floor dyssynergia and dyssynergic defecation) is a malfunction of the external anal sphincter and puborectalis muscle
Puborectalis muscle

The fibers which form a sling for the rectum are named the Puborectalis or Sphincter recti.They arise from the lower part of the symphysis pubis, and from the superior fascia of the urogenital diaphragm....
 during defecation
Defecation

Defecation is the final act of digestion by which organisms eliminate solid, semisolid or liquid waste material from the digestive tract via the anus....
. Normal defecation involves relaxation of both of these muscles. Malfunction involves their failure to relax or their paradoxical increased contraction
Contraction

Contraction may refer to:* Contraction , a contraction during childbirth * Contraction , a word formed from two or more individual words.* Syncope , the loss or reduction of sounds within a word....
. Anismus is a form of obstructed defecation and can cause constipation
Constipation

Constipation, costiveness, or irregularity, is a condition of the digestive system in which a person experiences hard feces that are difficult to expel....
. It is more common in women than in men, and sometimes is associated with sexual abuse
Sexual abuse

Sexual abuse, also referred to as molestation, is the forcing of undesired sexual acts by one person upon another. The offender is referred to as a molester/molestor/ abuser/sexual abuser....
. It occurs also in children, sometimes from birth.

Paradoxical contraction of the anal sphincter is fairly common and in many people it does not cause anismus.

Diagnosis

Physical examination can rule out anismus (by identifying another cause) but is not sufficient to diagnose anismus. Anismus needs to be distinguished from rectal inertia, another cause of obstructed defecation and constipation. Techniques proposed to do this include the rectal cooling test. Other techniques include manometry, balloon expulsion test, evacuation proctography, and MRI defecography. Diagnostic criteria are: fulfillment of criteria for functional constipation
Functional constipation

Functional constipation is constipation that does not have a physical or physiology cause. It may have a neurology, psychology or psychosomatic cause....
, manometric and/or EMG and/or radiological evidence (2 out of 3), evidence of adequate expulsion force, and evidence of incomplete evacuation.

Anismus can be classified by type:
  • Type I: paradoxical anal contraction
  • Type II: impaired propulsion
  • Type III: impaired anal relaxation with adequate propulsion

Complications

Complications of anismus may include fecal impaction
Fecal impaction

A fecal impaction is a solid, immobile bulk of Human feces that can develop in the rectum as a result of chronic constipation....
 and megarectum
Megarectum

Megarectum is a large rectum as a result of underlying nerve supply abnormalities or muscle dysfunction, which remains after disimpaction of the rectum....
.

Treatment

Biofeedback
Biofeedback

Biofeedback is a form of alternative medicine that involves measuring a subject's quantifiable bodily functions such as blood pressure, heart rate, body temperature, sweating, and muscle tension, conveying the information to the patient in real-time....
 is used to treat anismus, and for this purpose it is highly effective. However, when anismus occurs in the context of intractable encopresis
Encopresis

Encopresis, from the Greek ??p??? is involuntary "fecal soiling" in children who have usually already been toilet training. Children with encopresis often leak feces into their underwear....
 (as it often does), resolution of anismus 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 anismus.

Other therapies, such as botulin toxin type-A injections into the affected muscles have been considered. Historically, the standard treatment was surgical resection of the puborectalis muscle, but this has been found to be of no value.