Diagnosis and treatment of dyssynergic defecation

Satish S.C. Rao, Tanisa Patcharatrakul

Research output: Contribution to journalReview articlepeer-review

149 Scopus citations


Dyssynergic defecation is common and affects up to one half of patients with chronic constipation. This acquired behavioral problem is due to the inability to coordinate the abdominal and pelvic floor muscles to evacuate stools. A detailed history, prospective stool diaries, and a careful digital rectal examination will not only identify the nature of bowel dysfunction, but also raise the index of suspicion for this evacuation disorder. Anorectal physiology tests and balloon expulsion test are essential for a diagnosis. Newer techniques such as high-resolution manometry and magnetic resonance defecography can provide mechanistic insights. Recently, randomized controlled trials have shown that biofeedback therapy is more effective than laxatives and other modalities, both in the short term and long term, without side effects. Also, symptom improvements correlated with changes in underlying pathophysiology. Biofeedback therapy has been recommended as the first-line of treatment for dyssynergic defecation. Here, we provide an overview of the burden of illness and pathophysiology of dyssynergic defecation, and how to diagnose and treat this condition with biofeedback therapy.

Original languageEnglish (US)
Pages (from-to)423-435
Number of pages13
JournalJournal of Neurogastroenterology and Motility
Issue number3
StatePublished - 2016


  • Constipation
  • Defecation
  • Laxatives

ASJC Scopus subject areas

  • Clinical Neurology
  • Gastroenterology


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