Criteria for the diagnosis of pelvic floor dyssynergia:
(1) The patient meets the criteria for functional constipation (see above).
(2) There is measurable evidence during attempts to defecate of either:
(2a) inappropriate contraction of the pelvic floor muscles.
(2b) failure of the pelvic floor muscles to relax.
(3) There is evidence of adequate propulsive forces during the attempts to defecate.
(4) There is evidence of incomplete evacuation of stool.
Patients may complain of:
(1) excessive straining at stool
(2) feeling of incomplete evacuation of stool
(3) need to digitally assist stool removal
Patients may notice worsening of the condition during periods of stress, anxiety or depression.
Studies used to establish the diagnosis of pelvic floor dyssynergia:
(1) anorectal manometry
(2) electromyography of the external anal sphincter
(3) balloon defecation
(4) defecography
Adequacy of propulsive forces is determined by showing:
(1) increased intra-rectal pressure and/or
(2) abdominal wall contraction
Exclusion criteria:
(1) loose stools are not present
(2) insufficient criteria for irritable bowel syndrome (ie, does not meet the criteria for IBS).
