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Painful defecation
Medical expert of the article
Last reviewed: 04.07.2025
Dyschezia is a condition in which defecation is difficult. In dyschezia, patients are unable to defecate despite the sensation of stool and the need to defecate. This is due to a lack of coordination between the pelvic floor muscles and the anal sphincter. Diagnosis is made by anorectal manometry. Treatment is complex, but biofeedback may be effective.
[ Causes of painful bowel movements
Normally, during defecation, the increase in rectal pressure is coordinated with relaxation of the external anal sphincter. This process can be disrupted by weakening of the rectal contraction, paradoxical contraction of the anal sphincter, or its relaxation. Somatic causes include rectal prolapse and Hirschsprung's disease (a decrease in the number of intramural ganglia or their absence - aganglionosis). However, in most patients, the disorders are most likely associated with acquired psychoneurological disorders or a manifestation of irritable bowel syndrome; in 1/3 of these patients, psychoneurological problems can be traced back to childhood.
Symptoms, Signs, and Diagnosis of Painful Bowel Movements
Patients feel the urge to defecate, but even with prolonged straining and attempts to remove feces with fingers, defecation is difficult. Difficulties arise even with soft feces. The frequency of urges does not change or may be reduced.
Rectal and pelvic examinations may reveal increased tone of the pelvic floor muscles and anal sphincter. When straining, patients may not experience the expected relaxation of the anus and descent of the perineum. Rectoceles or enteroceles may be present, but they are usually not of primary pathogenetic significance. Long-term dyschezia with chronic straining may result in the development of a solitary rectal ulcer or rectal prolapse of varying degrees. Special radiographic studies (defecation proctography), anorectal manometry, and balloon examination of visceral sensitivity help to establish the cause.
Treatment of painful bowel movements
Treatment with laxatives is ineffective. Relaxation exercises and biofeedback may be effective, although a comprehensive approach is needed (physiotherapist, nutritionist, psychotherapist, gastroenterologist).