Do you also have difficulty going to the toilet? Is this a condition called anismus? Let's talk about this!

Do you sometimes feel like you have difficulty defecating or have a feeling of tightness when you go to the toilet? Do you feel like your bowels are not emptying for days, or do you feel like you have not passed out completely even after holding it in for a long time? These are problems that many people experience. But if these things continue, there may be a reason for it. The condition that we are going to talk about today is called anismus . Sometimes this is also called dyssynergic defecation .

Let's first see what Anismus is.

Simply put, anismus is a condition in which the muscles in your pelvic area do not work properly, causing difficulty in passing stool. Another name for this is a type of pelvic floor dysfunction .

Now imagine, your pelvic area is the area below your belly button. There are a lot of muscles there. Like a mesh, or a little cup, these muscles together hold organs like our bladder, uterus (in women), and rectum. We call this group of muscles the pelvic floor . These muscles are very important. Because, when we defecate and urinate, these muscles contract and relax to help with that process.

So, in the case of anismus, when you try to defecate, the muscles in the pelvic floor, especially around the anus, should relax. That's when the stool comes out easily. But in a person with anismus, instead of relaxing, these muscles tighten (paradoxical contraction) , or they don't relax at all (hypertonic pelvic floor) . Think of it like when you want to open a door, it closes even harder. For some people, these muscles are unable to generate enough force to expel stool.

Another thing is that about half of people with this condition have a decreased sense of having a bowel movement or a decreased sense of needing to have a bowel movement. So, when stools don't pass out on time, they get stuck in the intestines, become even drier, harder to pass, and more difficult to pass. This is one of the causes of chronic constipation .

How common is this condition? Who can get it?

Worldwide, it is estimated that 15% to 25% of people with chronic constipation may have anismus. Constipation is very common, affecting approximately 10% to 20% of people. Women are twice as likely to develop it as men. It is also more common in people over the age of 65.

Surprisingly, about a third of people with this condition have it in childhood.This starts. Another third may develop it after childbirth or an accident. For the remaining 40%, no clear cause has been found. Most of the time, it is thought to be an acquired behavior.

Why does anismus develop? What are the risk factors?

In fact, anismus is a functional disorder . That is, no specific physical or neurological disease has been found to cause it. It may be a response to stress, trauma, or chronic constipation, or it may be caused by the muscles becoming abnormal.

Although there is no specific cause for this, anismus can be seen in conjunction with certain conditions. That is, people with the following are more likely to develop anismus:

• Rectal ulcers
• IBS-C (Irritable Bowel Syndrome with constipation) – This is characterized by stomach upset along with constipation.
• Slow colonic transit time – This means that food moves slowly through the intestines.
• Chronic constipation since childhood.
• Rectal hyposensitivity – not feeling the sensation of passing stool.
• Psychological disorders.
• Use of certain painkillers (Opioid use).

What symptoms does a person with anismus experience?

People with anismus typically experience symptoms similar to those seen in severe constipation. These are the most common symptoms:

• Defecation less than three times a week.
• Excessive straining during bowel movements.
• The feeling that not all of the stool has come out even after defecating.
• Hard, painful bowel movements.
• Sometimes you have to use your fingers to help you get the stool out .
• Bloated stomach.
• Stomach pain.
• Anal pain.

You may feel embarrassed or embarrassed to talk about these symptoms. However, these are common symptoms of this condition. Telling your doctor about these things without hesitation will help them help you properly.

How is this anismus condition diagnosed?

When you see a doctor, they will first check to see if you have other common causes of constipation (such as structural defects, metabolic problems). This may include some basic rectal exams.

• First of allYou may be asked to do a digital rectal exam (DRE). This involves the doctor putting on gloves, applying a lubricant, and inserting a finger into your rectum.
• Then, a sigmoidoscopy test can be performed, which involves inserting a tube (scope) with a small camera inside.

If these tests do not find a clear cause, the next step is to perform several specific tests to see if anismus is present.

What are the special tests used to detect anismus?

Anismus is confirmed if at least two of these tests have abnormal results.

1. Anorectal manometry:

This involves measuring how the muscles in your anus and anal sphincter contract and relax. A small, flexible tube (catheter) is inserted into your anus. A healthcare professional then inflates the catheter. A machine records how your muscles respond, as if they were full of stool. This test can detect:

• Is it possible to create enough pushing force to expel feces?
• Do the muscles in the anal sphincter relax properly when you push?
• Or, do those muscles get tighter when you push?
• Is your rectal sensation normal?

2. Balloon expulsion test:

This measures how long it takes you to pass something like stool through your anus. To make it look like a stool, a balloon filled with warm water is inserted into your anus and inflated to a certain size. You are then asked to sit on the toilet and pass it. If this takes more than a minute , it may indicate a problem with the functioning of your pelvic floor muscles.

3. Defecography:

In this test, X-rays or MRIs can be used to see how the muscles inside your body work as you try to pass a bowel movement. A paste that looks like stool is inserted into your rectum, and you are asked to sit on the toilet and pass it. The X-ray or MRI images are then displayed on a screen. This can help detect any problems with the functioning of your pelvic floor, as well as other structural problems.

4. Sitz marker study:

This measures how quickly food moves through your intestines. First, your doctor will give you a pill to take. The pill contains small markers that can be seen on an X-ray. Five days after taking the pill, you will have another X-ray. If the markers are still in your colon on the X-ray, it means that waste products are not moving through your colon normally.

What are the treatments for this condition called anismus?

The good news is, there is a treatment for this! The most effective treatment currently available is biofeedback . It has an 80% success rate. This is the mainstay of treatment. However, your doctor may suggest other treatments or alternatives if biofeedback doesn't work for you.

Here are some treatment options:

1. Biofeedback therapy:

This is a wonderful psycho-physical physiotherapy method. It's like practicing controlling your body's muscles with your mind. Small, painless devices called electrodes are placed on your skin, and your heart rate, breathing pattern, skin temperature, muscle tension, and brain activity are displayed on a screen for you and the therapist to see.

Then, the therapist will teach you various exercises, muscle contractions, and relaxation techniques. As you do these exercises, you can watch the results on the screen and learn how to control your muscles properly. By practicing this way, you will be able to push properly to pass stool and relax the muscles around your anus properly.

Biofeedback can also help you increase your sensory awareness. Some people have rectal hyposensitivity. With this training, you will start to feel the need to defecate more quickly.

2. Lifestyle remedies:

Whether you're undergoing biofeedback therapy or not, your doctor will usually tell you to make some lifestyle changes, such as these, to help make the bowel movement process easier:

• Avoid constipating medications.
• Drink enough water throughout the day.
• Eat plenty of fiber-rich foods (vegetables, fruits, legumes, whole grains).
• Take a short walk after every meal.
• Go to the toilet as soon as you feel the need to defecate. Don't put it off.
• Try to go to the toilet at the same time every day (for example, after breakfast).

3. Constipation medications:

If other methods don't work, your doctor may prescribe a laxative ( laxative ) to relieve constipation.Other medications may be prescribed. These medications are not specifically designed for anismus. However, they usually provide relief for long-term constipation. Even if the muscle problem is not corrected, they can help prevent the stool from becoming too hard and difficult to pass.

4. Botox® injections:

Botulinum toxin injections have been used to treat anismus, but the results have been mixed. Botox is usually used to relax muscles (much like it is used to reduce wrinkles). However, this is only about 50% effective for anismus. This may be because anismus is more complex than just muscle contraction. However, it seems to be more effective in children.

What is the future for those living with Anismus? (Outlook)

If you have access to biofeedback therapy, it may be helpful. However, doctors say that this treatment is not readily available to everyone. In-home biofeedback devices are also being developed. You may also find some relief with medications for constipation and lifestyle changes.

Doctors always take constipation, especially if it's chronic, very seriously. If you have symptoms of anismus, see a doctor right away . This can be a difficult topic to talk about, but it's better than keeping the illness to yourself.

Talk openly with your doctor about your symptoms. Remember, they are the ones who hear and see these things every day. If you can, keep a “poop journal” before you see your doctor. That is, write down what happened each time you went to the toilet, how long it took, and how difficult it was. The more information you provide, the easier it will be for your doctor to help you.

Take-Home Message

• Anismus is a constipation-related condition caused by the pelvic floor muscles not relaxing properly during bowel movements and tightening.
• This can develop in anyone of any age, but is more common among women and the elderly.
• Symptoms include excessive straining, incomplete evacuation of stool, hard stools, and abdominal pain.
• Don't worry, there are special tests to detect this, and a treatment called biofeedback is very effective.
• If you have these symptoms, it's important to seek medical advice without feeling embarrassed or embarrassed. The sooner you start treatment, the sooner you can recover.

` Anismus, dyssynergic defecation, constipation, pelvic floor muscles, biofeedback, toileting difficulties, bowel movements