Constipation and other bowel troubles are an incredibly common experience worldwide. However, many people may not consider that their pelvic floor muscles could be a part of the problem. Your pelvic floor is a group of muscles that help with a variety of important tasks, including relieving oneself.

Therefore, individuals struggling with bowel movements may be experiencing some form of pelvic floor dyssynergia, which refers to the condition where the pelvic floor muscles are unable to coordinate properly during bowel movements.

If you think you have some form of pelvic floor dysfunction or pelvic floor dyssynergia, no need to panic. There are many treatment options available to you, many of which usually involve working with a pelvic floor physical therapist. But first, let’s dig a little deeper into some terminology that relates to pelvic floor dyssynergia.

The term “dyssynergia” refers to the incoordination of the muscles. But it isn’t the only term used to describe pelvic floor conditions. Some other closely related or alternative terminology that you should know include:

• Anismus: 
  • This term is often used interchangeably with pelvic floor dyssynergia, and highlights the specific dysfunction in the anal sphincter during defecation.
• Paradoxical Puborectalis Contraction: 
  • This describes the condition more specifically by focusing on the paradoxical or inappropriate contraction of the puborectalis muscle (part of the pelvic floor) during attempts to have a bowel movement.
• Dysfunctional Defecation: 
  • A broad term that encompasses various types of defecation disorders (including pelvic floor dyssynergia), indicating a general difficulty with the defecation process.
• Outlet Dysfunction Constipation: 
  • This term emphasizes the constipation aspect caused by being unable to properly coordinate muscle movements, which would allow for stool passage.
• Pelvic Floor Dysfunction: 
  • While this is a broader term, pelvic floor dyssynergia falls under the umbrella of pelvic floor dysfunction. It includes any disorder affecting the coordination and function of the pelvic floor muscles.
• Non-relaxing Pelvic Floor Dysfunction: 
  • Specifies that the pelvic floor muscles are not relaxing as they should during bowel movements, urination, or sexual activity.

It can be helpful to be familiar with these terms so that you can best communicate with healthcare providers and better understand educational sources! As you may notice, all of these terms are closely related or very similar. They have very subtle differences in meaning, but that difference is very important when receiving a proper diagnosis and treatment.

Understanding the differences between these terms will help you better understand your specific condition and diagnosis given by a healthcare professional.

So, focusing specifically on pelvic floor dyssynergia, let’s look at what symptoms you could experience with this condition. This condition can create a variety of symptoms that reflect the challenges associated with the evacuation of stool. Keep in mind that because the pelvic floor is responsible for many different roles in the body, some other functions can be affected in addition to bowel movements. Some common symptoms may include:

• Chronic Constipation: 
  • Difficulty making bowel movements or infrequent bowel movements. This can cause excessive straining to pass stool.
• Feeling of Incomplete Evacuation: 
  • The sensation that the bowels have not been fully emptied or that not all stool has passed after a bowel movement. Can lead to discomfort and the need for frequent trips to the bathroom.
• Straining During Bowel Movements: 
  • The inability to coordinate muscle movements properly can cause excessive straining when initiating and completing a bowel movement.
• Painful Defecation: 
  • The process of having a bowel movement may become painful due to the straining and constipation associated with pelvic floor dyssynergia.
• Bowel Movement Urgency: 
  • This describes the sudden urge to defecate, but may result in difficulty passing stool once a bowel movement is initiated.
• Need for Manual Assistance: 
  • In some cases, manual maneuvers may be necessary to facilitate bowel movements, such as applying pressure to the perineum or using a finger to evacuate stool from the rectum.
• Pelvic Pain: 
  • Chronic pelvic pain or discomfort, not solely related to bowel movements, can also be a symptom. 
• Frequent Urination or Difficulty Urinating: 
  • Pelvic floor dyssynergia can also impact urinary functions, leading to symptoms such as a frequent need to urinate or difficulty starting urination.
• Sexual Dysfunction: 
  • In some cases, the condition can affect sexual function, leading to pain during intercourse or difficulty achieving arousal or orgasm. 

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Now that you understand the specific condition that pelvic floor dyssynergia describes and what symptoms you may experience with it, let’s talk about the possible causes.

This condition is still being researched, but there are certain causes that may contribute to or are thought to increase the risk of pelvic floor dyssynergia. These causes can include:

• Neurological Issues:
  • Abnormalities or dysfunctions in the nerves that control the pelvic floor muscles can disrupt the normal relaxation and contraction process required for bowel movements.
• Chronic Constipation and Straining: 
  • Long-term constipation and the frequent straining it encourages can lead to or exacerbate pelvic floor dyssynergia. Over time, this straining can alter the normal function of the pelvic floor muscles.
• Psychological Factors: 
  • Stress, anxiety, and other psychological conditions can manifest physically, affecting bodily functions including the pelvic floor. Some individuals may unconsciously tighten their pelvic floor muscles in response to stress, which can contribute to pelvic floor dysfunction.
• Physical Injury or Trauma: 
  • Injury to the pelvic area, such as from surgery, childbirth, or accidents can damage the muscles or nerves of the pelvic floor.
• Improper Toilet Habits: 
  • Sitting positions or habits that do not support the natural physiology of defecation can contribute to the development of dyssynergic defecation. For example, sitting in a position that does not facilitate the straightening of the recto-anal angle can lead to difficulties with stool passage.
• Sedentary Lifestyle: 
  • Lack of physical activity can weaken the pelvic floor muscles, contributing to dysfunction.
• Pelvic Floor Muscle Weakness or Tightness: 
  • Both weakness or tightness can disrupt the normal relaxation and contraction cycle necessary for defecation. 
• Behavioral Conditioning: 
  • Some individuals may inadvertently train their pelvic floor muscles to contract rather than relax during attempts to defecate, especially if they have experienced pain during bowel movements in the past.
• Other Factors:
  • Other factors such as aging, medications, or the presence of gastrointestinal conditions may contribute to pelvic floor dyssynergia.

Physical therapy can be a huge help when it comes to pelvic floor dyssynergia. After all, the phrase itself refers to incoordination of pelvic floor muscles—something pelvic floor physical therapists are experts in!

While the specific treatments your physical therapist will use vary depending on your individual needs and symptoms, they will be able to help identify possible root causes and create a customized treatment plan just for you!

Working with a physical therapist can help you better understand your pelvic floor and the structures that affect this important muscle group. They will utilize treatments such as muscular re-education and biofeedback to help you regain control of these muscles.

They will also help you identify possible behaviors that could be contributing to your symptoms or pelvic floor dysfunction, and suggest healthier lifestyle changes, exercises, and more.

For some patients with pelvic floor dyssynergia, pain relief treatments may also be necessary. Manual therapy can be great for managing pain from this condition as well as therapeutic activity, which can make overall symptoms more manageable and improve your quality of life.

Additionally, relaxation techniques and stress management will be very important for managing and treating pelvic floor dyssynergia.

The pelvic floor physical therapists at Hive Therapy and Wellness may use the following treatments for pelvic floor dyssynergia:

• Manual Therapy
• Exercise Prescription
• Behavioral Modifications
• Neuromuscular Re-education
• Biofeedback (part of neuromuscular)
• Therapeutic Activity