Do I Have IBS?
Melissa G. Hunt, Aaron T. Beck in Reclaim Your Life From IBS, 2022
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.
Discussions (D)
Terence R. Anthoney in 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
Evolution and follow-up of lower urinary tract dysfunction in spinal cord–injured patients
Jacques Corcos, David Ginsberg, Gilles Karsenty in Textbook of the Neurogenic Bladder, 2015
Bladder overactivity is harmful in SCI patients because it is associated with bladder-sphincter dyssynergia. In suprasacral lesions,33 7.4% of patients have no dyssynergia, 80.3% have intermittent dyssynergia, and 12.3% have continuous dyssynergia. Complete spinal cord lesion is usually accompanied by continuous dyssynergia, whereas intermittent dyssynergia is seen only with incomplete lesion. Dyssynergia is associated with complete lesions, with high intravesical pressure, and with upper urinary tract complications. These associations are more pronounced in continuous dyssynergia than in intermittent dyssynergia. The proportion of patients suffering from a particular type of bladder-sphincter dyssyn ergia has not changed with time.
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.
Genital nerve stimulation increases bladder capacity after SCI: A meta-analysis
Published in The Journal of Spinal Cord Medicine, 2018
Dennis J. Bourbeau, Graham H. Creasey, Steven Sidik, Steven W. Brose, Kenneth J. Gustafson
Neurogenic detrusor overactivity (NDO) can severely impair a person's health and quality of life. Restoring bladder function is considered a high priority by individuals with spinal cord injury (SCI).1 Individuals typically experience spontaneous and uncontrolled bladder contractions in response to bladder filling, resulting in decreased bladder capacity and urinary incontinence. If bladder contractions are concomitant with reflex contractions of the urethral sphincter, termed detrusor-sphincter dyssynergia, then the individual may have difficulty with bladder emptying. Bladder contractions in these cases are associated with episodes of autonomic dysreflexia and can lead to renal damage.2 Current interventions, including catheterization strategies, medications, and surgical approaches incompletely address the problem of bladder overactivity and have unwanted side effects.
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.
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