Deborah Bethards, M.D.
Most gastroenterologists have encountered patients who complain of chronic constipation. Colonoscopy shows no anatomical abnormalities. Nonetheless, conservative treatment with laxatives and bulking agents brings only temporary, minor relief. After several failed treatment attempts, the patient is distressed, uncomfortable and anxious; the gastroenterologist is frustrated. Deborah Bethards, M.D., a gastroenterologist at Penn State Hershey Medical Center’s Neurogastroenterology and Motility Clinic explains, “Failure of conservative treatment to resolve constipation should be a red flag. With no other detectable abnormality, the possibility of a chronic pelvic floor disorder that primarily affects women—known as dyssynergic defecation—should be considered.”
With this disorder, the rectosigmoid area does not function properly so that during attempted defecation, paradoxical anal contraction occurs, and pelvic floor muscles fail to relax. The result is that stool is retained in the rectum. If left untreated, complications such as fecal impaction, rectocele, megacolon, and fecal incontinence may occur. Continue reading
