Defecation is a coordinated process that involves generation of sufficient propulsive forces in the abdomen and rectum combined with relaxation of the puborectalis and external anal sphincter muscles. Defecation disorders are functional or structural anorectal processes that disrupt this coordinated effort and result in chronic or recurring difficulty in evacuating stool from the rectum. They are common and can affect up to 50% of patients with chronic constipation. Symptoms alone are often insufficient to distinguish patients with defecation disorders from those with other types of constipation. The definitive diagnosis is usually made using a combination of a clinical history of chronic constipation and the abnormal diagnostic test results (balloon expulsion, defecography, electromyelography, anal rectal manometry). This multidisciplinary panel will discuss the clinical symptoms of defecatory disorders, the physical examination findings and diagnostic tests employed to make the diagnosis, and the various therapeutic options available to treat the condition.
Summarize the physiology of colonic motor and pelvic floor functions and pathophysiology of chronic constipation
Describe the clinical features, diagnostic tests, and medical management of chronic constipation
Describe the differences in types of constipation and when surgery may be indicated and what type of surgery would be appropriate
Identify at least three bowel disorders, patient symptoms or patient findings which would benefit from a referral to pelvic physical therapy
Identify at least three different physical therapy modalities available for the treatment of dysenergia