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Do I Have IBS?
Published in Melissa G. Hunt, Aaron T. Beck, Reclaim Your Life From IBS, 2022
Melissa G. Hunt, Aaron T. Beck
Dyssynergic defecation is common and affects up to one-half of patients with chronic constipation. Basically, it occurs when the muscles in the pelvic floor don’t work together with the muscles in the rectum and the abdomen to coordinate when you’re trying to push poop out. Normally, when a person poops, there is a rise in rectal pressure, which is synchronized with a relaxation of the external anal sphincter. Dyssynergia happens these processes aren’t properly coordinated. This may be due to inadequate pushing force, paradoxical anal sphincter contraction, impaired anal sphincter relaxation, or a combination of these mechanisms. For example, the muscles in the rectum may contract, but the pelvic floor muscles (including the anal sphincter) don’t relax enough to let the stool pass out of the anus. Symptoms of dyssynergia include excessive straining, infrequent bowel movements (less than three times per week), hard dry stool, and feelings like you can’t get it all out (incomplete evacuation). In fact, there’s a lot of overlap between the symptoms of dyssynergia and the symptoms of constipation-predominant IBS.
Peripheral and Intravesical Electrical Stimulation of the Bladder to Restore Bladder Function
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
One strategy is to attempt to prevent or reduce the occurrence of detrusor-sphincter dyssynergia (DSD). Sievert and colleagues90 investigated patients with complete SCI who were in the early, areflexic stages following injury. They demonstrated that those treated with SNM had fewer incidents of urinary tract infection (UTI), greater urinary continence with higher bladder capacities, and improved bowel control, contributing to their increased quality of life.
Discussions (D)
Published in Terence R. Anthoney, Neuroanatomy and the Neurologic Exam, 2017
Many authors of recent textbooks in clinical neuroscience do not use the term “dyssynergia” (or “asynergia”) at all (e.g., Barr, T&D, Bann, Bick, Walt, S&M, G&M, Marg, Ross).14 Among authors who do use the term “dyssynergia,” the specificity of usage varies. The broadest usage essentially equates “dyssynergia” with “ataxia” = “loss of coordination”15 (e.g., MP&S, p. 80), a definition which is also found in a recent medical dictionary (Hensyl, 1982, p. 135 (“ataxia”], 436 [“dyssynergia”]). Massey, Pleet, and Scherokman, for example, include as “dyssynergia” a wide variety of findings secondary to cerebellar dysfunction, such as nystagmus, ocular dysmetria, scanning and explosive speech, titubation, dysmetria (though not labelled as such), and dysdiadochokinesia (1985, p. 23–24, 80–84).16
Clinical value of positive BET and pelvic floor dyssynergia in Chinese patients with functional defecation disorder
Published in Scandinavian Journal of Gastroenterology, 2022
Ya Jiang, Yan Wang, Yurong Tang, Lin Lin
However, there are some limitations as follows. First, this study was performed with data retrospectively analyzed in a single tertiary care center and questionnaire investigation was not carried out in all the FDD patients (only 177 out of 335) who had undergone ARM and BET, resulting in data scarcity and lack of universality. Second, function testings were not performed following London Protocol because it was a retrospective study when London Protocol was not available between 2015 and 2019. Furthermore, position is a key component as demonstrated in a study recruiting 25 healthy people that found an increase in dyssynergia in the left lateral position (36%) compared with the seated position (20%) [49]. Left lateral position was adopted for BET, which might be linked to low specificity of BET in our study compared to others’ results and that is why we take 3 min as a cut-off value (instead of 1 or 2 min). However, concordance between BET performed in the left lateral position or seated position was observed in a previous study [50]. At last, as DRE is not a common exam in our outpatient, only few patients underwent it and the data could not be tracked due to retrospective investigation. Some prospective studies are needed in the future.
Intravesical electromotive administration of botulinum toxin type A in improving the bladder and bowel functions: Evidence for novel mechanism of action
Published in The Journal of Spinal Cord Medicine, 2021
Abdol-Mohammad Kajbafzadeh, Hamed Ahmadi, Laleh Montaser-Kouhsari, Shabnam Sabetkish, Sanam Ladi-Seyedian, Masoud Sotoudeh
In one study,22 the effects of sphincteric botulinum toxin A injection has been evaluated in patients with external sphincter dyssynergia. The results demonstrated the efficacy of this method in the treatment of refractory nonneurogenic voiding dysfunction in these selected children. According to the study of Hollingshead et al., functional anal pain as a result of sphincter muscles spams can be also treated by injecting of BoNTA into the internal anal sphincter.23 The result of another study demonstrated the efficacy and safety of intravesical BoNTA injection for treatment of cystitis/bladder pain syndrome (IC/BPS).24 The retrograde transport of BoNT/A to the CNS after bladder injection has been also verified in a rat model by using the gamma-emitting radionuclide technetium-99m (99mTc).25 The results of the current study regarding the positive BoNTA staining in the pelvic floor muscle samples are in accordance with another study in which it has been confirmed that the injection of BoNTA can be effective in the treatment of refractory chronic pelvic pain related to pelvic floor muscle spasm.26
Change in urodynamic pattern and incidence of urinary tract infection in patients with traumatic spinal cord injury practicing clean self-intermittent catheterization
Published in The Journal of Spinal Cord Medicine, 2020
Osama Neyaz, Venkataraman Srikumar, Ameed Equebal, Abhishek Biswas
In our study, road traffic accident (54.8%) was the major cause of SCI followed by fall from height (41.9%). All the patients were admitted within a year of SCI, and mean duration of injury at time of admission was 3.6 ± 1.5 months. Follow-up was done at re-admission between 6 months to 1 year post discharge; with a mean of 11.4 ± 2.4 months. The neurological level of injury was thoracolumbar spinal cord in all cases, and most common level was T12 and L1 (45%). At the first admission, 61.3% patients had a complete injury (AIS A) and 38.7% were having incomplete injury (AIS B). In all our patients, renal function was within normal limits at baseline and follow-up which indicates that there was no deterioration of renal function in any patient during the observation period. In our study, the baseline cystometric study showed 15 (48.4%) had overactive detrusor and 16 (51.6%) had DA at baseline and on follow-up the type of detrusor pattern remained same in all participants, though neurological level of injury improved. We cannot comment on detrusor sphincter dyssynergia because electromyography was not included in our urodynamic studies. The aim of this study was to prospectively evaluate urodynamic changes in individuals with SCI practicing CIC so that we may be prepared for the long-term complications in spite of CIC and also to observe/compare prospectively the urodynamic bladder profile of two sub-groups, namely the overactive detrusor group and the DA group. Prospective urodynamic evaluation studies and the profile of microbes causing UTI in individuals with traumatic SCI in the Indian context is highly under-reported.