Chapter 1 20 Pelvic floor (dys)function and defecation Defecation is the term given for the act or process of expelling feces from the digestive tract via the anus.33 The integrity of the defecation and continence mechanism is a multifactorial process that involves somatic and visceral functions.34 Normal defecation requires anorectal synchronisation, an intact rectal sensation and perception, a contraction of the abdominal muscles and relaxation of the EAS and puborectalis muscle.20 During defecation, the voluntary effort of bearing down increases the intra-abdominal pressure, together with contraction of the rectum and the perineal muscles. To evacuate stool, the anal sphincters relax and the puborectalis muscle relaxes for straightening the anorectal angle.20 When the EAS and puborectalis muscle do not relax or even contract during attempted defecation this could result in an increase in the anorectal angle and hence prohibits the normal passage of stool.35 Preston,36 was the first describing the association of paradoxal anal contraction during attempted defecation and called the term ‘anismus’. The Rome-criteria advocated the term dyssynergic defecation.37 Dyssynergic defecation or dyssynergia is an acquired behavioral disorder and can be characterized by inadequate anal relaxation, paradoxical anal contraction, or inadequate rectal propulsive forces.38 Patients experience complaints of excessive straining, a feeling of incomplete evacuation, abdominal pain, abdominal discomfort, and anorectal pain.39,40 According to the ROME IV criteria, dyssynergia is established by 2 out of 3 anorectal function tests:
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