Dyschezia

Classification according to ICD-10
K59.0	Dyschezia
ICD-10 online (WHO version 2019)

Under dyschezia ( ancient Greek δύς dys- , German, bad 'and χέζειν chezein , German, defecating') refers to difficulty in defecation ( defecation ). Although an urge to defecate is felt, the stool cannot be passed normally. This inability is due to a coordination disorder of the anal sphincters on the one hand and the pelvic floor muscles on the other.

root cause

Dyschezia can occur with rectal prolapse . Possible causes are also: frequent suppression of the voiding reflex, frequent enemas, Hirschsprung's disease , inflamed hemorrhoids , irritable bowel syndrome and anal fissures . Dyschezia can also be a sign of endometriosis .

Disease emergence

Normally, during defecation, the pressure in the rectum is increased and at the same time the external sphincter muscle of the anus (muscle sphincter ani externus) relaxes . If the rectal contraction is reduced or the tone of the sphincter muscle (anal sphincter) increases, this process can be disturbed.

In rectovaginal endometriosis, rectal stenosis can occur. This is one of the most serious complications of endometriosis. This can lead to an infiltration of the serosa and the muscularis of the rectum. The mucosa of the rectum is usually not affected. The fibrotic remodeling of the endometriosis then leads to stenoses.

frequency

The frequency of dyschezia in the various causative diseases is unknown.

Clinical manifestations

Patients usually report pain during bowel movements, changing consistency of the stool ( diarrhea and constipation ), flatulence , spasms , tenesms (painful urge to defecate ) and nausea. In cycle dependence of the symptoms of endometriosis between the vagina (can vagina ) and rectum ( rectum ) can be assumed.

Investigation methods

Examination of the pelvis and rectum may show hypertension of the pelvic and anal muscles. A rectocele or enterocele may be present, but they are not necessarily causal. If the symptoms persist for a long time, there may be rectal prolapse. A special X-ray examination, called defecation proctography , can be helpful in making the diagnosis . Anorectal manometry and balloon expulsion can be used for further diagnostics .

treatment

Treatment should be based on the cause. Therapy with laxatives is not satisfactory. The symptoms can be improved using biofeedback . If there is extensive recto-vaginal endometriosis, surgery should be considered.

See also

• Irritable bowel syndrome

literature

• Gerhard Pott: Colonoscopy Atlas . Schattauer, 2003, ISBN 3-7945-2288-5 ( limited preview in Google book search).

Individual evidence

1. ↑ ^{a b} Mark H Beers: The MSD Manual of Diagnostics and Therapy. Elsevier, Urban & Fischer, 2007, ISBN 3-437-21761-5 ( limited preview in Google book search).
2. ↑ ^{a b c} Andreas D. Ebert: Endometriosis: A Guide to Practice. Walter de Gruyter, 2006, ISBN 3-11-018984-4 ( limited preview in the Google book search).
3. ^ LC Giudice, LC Kao: Endometriosis. In: Lancet. 364 (2004), pp. 1789-1799, PMID 15541453 , doi : 10.1016 / S0140-6736 (04) 17403-5
4. ↑ Peter Bernius, Winfried Rief, Niels Birbaumer: Biofeedback . Schattauer, 2006, ISBN 3-7945-2395-4 ( limited preview in Google book search).
5. ↑ SS Rao: Dyssynergic defecation and biofeedback therapy. In: Gastroenterol Clin North Am. 37 (2008), pp. 569-586, PMID 18793997

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !