A defecation disorder is a situation where the stool is in the rectum, the urge is there, and yet nothing happens, or it takes many minutes of straining. Patients describe it as incomplete emptying, a blockage, having to return to the toilet repeatedly, and sometimes having to help with their fingers.
The most common cause is pelvic floor dyssynergia: at the moment of straining the sphincters and the levator ani should relax, and instead they contract. This is a coordination problem, not weakness - which is why strengthening exercises alone, Kegel exercises included, can make things worse here.
In dyssynergia, physiotherapy with biofeedback is the approach with the best evidence behind it - more effective than laxatives, which have no way of addressing this mechanism. The learning happens on a visible signal from your own muscles, because without it the difference between contracting and releasing is hard to feel in a place you cannot see.
Therapy
- History and a bowel diary
- Functional examination: what the pelvic floor does when you strain
- Coordination training: releasing the sphincters while the abdomen works
- Biofeedback - learning from a visible signal from your own muscles
- Correcting toilet posture and daily routine
- Breathing and diaphragm work
- A home programme