A Proctological Disease That Should Be Keep in Mind in the Patient Presenting with Chronic Constipation: Dyssynergic Defecation

Pelvic Floor Diseases and Dyssynergic Defecation

Abstract

I read with interest the article titled "A Rare Cause of Chronic Constipation in Family Medicine Practice: Dyssynergic Defecation" published by Öztürk et al. in your journal (1). The 32-year-old female patient mentioned in the article has a chronic constipation problem that started in childhood and the systematic diagnosis and treatment protocol applied for this problem actually advises us that there should be an algorithm that should be applied to every patient presenting with chronic constipation. The regression of the patient's complaints after this diagnosis and treatment process shows us once again that a correct diagnosis is a must for the patient to benefit from the treatment.

Rao et al. In a systemic review published by them, dyssynergic defecation is defined as a lack of coordination of the rectoanal, abdominal and pelvic floor muscles necessary for proper relaxation and is said to be characterized by inadequate anal relaxation, paradoxical anal contraction or inadequate rectal thrust forces (2). In other words, in this disease, there is no pathology that would cause constipation in the proximal parts of the colon.

In a recently published study, 84% of patients described excessive straining during defecation, 76% experienced a feeling of incomplete evacuation, and 74% had abdominal bloating (3). However, these constipation-related symptoms appear to be better predictors of colonic slow transit than pelvic symptoms. This makes it difficult to diagnose dyssynergic defecation based on history alone (3). Therefore, using the same approach as in your article, it should be kept in mind that the etiology of chronic constipation should not be sought only in intra-abdominal pathologies, but that the cause may be a disease of proctological origin, such as dyssynergic defecation. I congratulate you for your article in terms of emphasizing this important issue.