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Pelvic Dysfunction

In some cases, the cause of constipation is dysfunction of pelvic muscles or organs. Some of these conditions are caused by repeated avoidance of the natural urge to have a bowel movement or too much straining during bowel movements, as well as damage resulting from pregnancy and vaginal childbirth.

Pelvic Dyssynergy
Pelvic dyssynergy is an inability to coordinate the complex interchange of consciously controlled and unconsciously controlled pelvic and anal muscles involved in defecation. Pelvic dyssynergy can be diagnosed using anal electromyography (EMG), which measures electrical activity of anal muscles, or a balloon expulsion test, which measures how long it takes a patient to push a water-filled balloon out of their rectum. Treatment for pelvic dyssynergy may start with pelvic floor physical therapy and biofeedback techniques to help heal, strengthen, and retrain the pelvic and defecatory muscles. Botulinum toxin injections can be used by a physician to augment physical therapy in order to relax muscles that cannot achieve it naturally.

Rectocele*
A rectocele is a condition in women in which the front of the rectum protrudes, or balloons, into the back of the vagina. A physical examination is usually sufficient to diagnose a rectocele, but a provider may use defecography, a video x-ray of the area around the rectum and anus, to further assess the problem. Treatment may start with dietary changes and biofeedback, but surgery may be necessary in some cases.

Rectal Intussusception and Prolapse
Rectal intussusception and prolapse are conditions in which all or part of the rectum slips downward. Intussusception is also called incomplete prolapse. Overt or complete rectal prolapse means the rectum has slipped outside the anus. These conditions can cause other serious problems, including swelling of the rectal wall and rectal ulcers.** Soft stool and avoiding straining with bowel movements are essential in managing this condition. Biofeedback to retrain pelvic floor muscles often improves symptoms, but surgery may be required for patients with a rectal ulcer.

Enterocele
An enterocele is a condition in women in which the small intestine protrudes into the area between the rectum and the vagina. Dietary changes and biofeedback are usually sufficient to treat an enterocele, but surgical repair is sometimes done at the same time as a hysterectomy or in conjunction with surgical repair of another pelvic condition.

Pelvic Organ Prolapse
Prolapse of pelvic organs means that one or more organs in the pelvic region has slipped downward. Pelvic floor physical therapy assessment is appropriate, and may cure dysfunction. If it is not successful, or prolapse is severe, surgery is done to restore organs to their appropriate anatomic positions and to reconstruct support tissues.

*Although this condition predominantly occurs in women, rectoceles in rare cases can affect men, typically in association with having had a prostate removal. Additionally, rectoceles with protrusions to the side and toward the back have been reported in both women and men.

**Loss of blood flow to the protruding rectal tissue is another potential complication of rectal intussusception and prolapse.