The term dischezia identifies a form of primitive constipation, in which the expulsion of the faeces is difficult due to a functional or morphological alteration of the rectum. In the absence of other disorders, therefore, the motility of the upper tracts of the colon is normal and the stool transit is slowed down only at rectal level.
Dyschezia from functional causes
In the absence of anatomical alterations or underlying diseases, dyschezia is often the consequence of an incorrect lifestyle. In particular, the weakness of the abdominal muscles and the pelvic floor - a consequence of sedentariness, aggravated by pregnancy and aging - compromises the efficiency of the abdominal press even during defecation. If this is associated with the habit of postponing defecation, the accumulation of faeces in the rectal ampule gradually tends to weaken it, making it less sensitive to stimuli originating from the state of distension of its wall. Consequently, more and more stools are needed to relax the ampoule and give rise to the stimulus of defecation.
Among the muscles whose weakness or lack of coordination can cause dyskidia, we remember the pubo-rectal muscle, involved in the so-called pubo-rectal syndrome . If this muscle contracts during defecation instead of relaxing, there is an acute increase in the rectal-anal angle that triggers the problems of obstructed defecation.
Dyschezia from pathological or iatrogenic causes
Dyschezia can also depend on painful affections of the anus (fissures, anism), which lead the patient to postpone defecation due to the pain it evokes.
Other causes of dyschezia include endometriosis, rectocele, rectal prolapse, cystocele, colpocele (in women) and Parkinson's disease.
Chronic laxative abuse can promote the aony of muscles involved in defecation.
Associated symptoms
In the presence of dischezia defecation is painful and there is a perception of a foreign body in the rectum.
The voluntary inhibition of the defecation, caused by the pain, feeds a vicious circle, in which the patient can lose the natural ability to contract some muscles and release others (dissociation of the pelvic floor) during the defecatory act.
Complications
Chronic constipation traumatizes the rectal mucosa and can damage it, causing the so-called solitary ulcer of the rectum. The wound can lead to rectorrhage and mucorrhea, or the loss of blood from the rectal origin and / or mucus from the anus.
The weakening of the muscles and ligaments that support the rectum in its natural position can determine its prolapse, that is, the exit from the anus.
Diagnosis
Anorectal manometry
In the diagnosis of constipation due to obstructed defecation, the so-called anorectal manometry is particularly important. This exam consists in the introduction of a small sensor in the anal canal and in part of the ampoule, connected to a computerized system that records the pressures exerted on its walls.
With the collaboration of the patient, who must punctually comply with medical requests, anorectal manometry is therefore capable of assessing the strength of the muscles involved in the continence of the rectal ampulla and those responsible for the physiological evacuation of the stool. It also allows to evaluate how the rectum responds to the evacuative stimulus. All this is possible thanks to the inflation and deflation of a balloon inserted in the rectum and connected to the probe.
Balloon expulsion test
The doctor places a balloon in the patient's rectum, inflating it with 50cc of air. The distension of the rectal walls should trigger the stimulation of defecation and the expulsion of the same balloon. If the subject is unable to expel the balloon, there is a dysfunction of the pelvic floor.
defecography
See the dedicated article.
Treatment
In addition to the treatment of any underlying pathological causes, the so-called reeducation of the alvo is important through biofedback or sphincter re-education . This is a series of exercises to be performed under medical supervision and with the aid of computerized equipment, which helps the subject to learn the mechanism of defecation in real time. The intervention aims to train the patient to contract certain muscles and release others during the act of defecation. It is practiced in a similar way to the manometry, then inserting in the rectal ampulla a latex probe equipped with a balloon at the end.
The same purpose is also pursued by electro-stimulation. It is a form of passive gymnastics, which induces the contraction of the muscle fibers through a slight electric current applied through one or more electrodes inserted in the anal canal.
The practice of regular physical activity of a general nature is certainly useful in the event of disharmony. It can also benefit from the adoption of a varied diet, rich in water and soluble fiber, and the fact of following a specific time for the evacuation of the animal.
