GSC Newsletter (10) - Flipbook - Page 3
PATIENT CASE DrSTUDY
Tom Worland
Barry* is a 26 year old IT professional referred with
a decade long history of abdominal complaints on the
background of type 1 diabetes and ADHD.
Since he was 17, Barry had had issues with his bowels. Barry had the urge to open his bowels
up to four times per day but each time he would attempt to evacuate his bowels he would
need to spend up to 30 minutes on the toilet with significant straining. Despite his efforts, he
would typically only ever pass one small volume motion and suffer significant post defecation
tenesmus. He had no significant bloating and abdominal pain was minimal. His symptoms had
been escalating, and he felt quite miserable now spending up to two hours sitting on the toilet
every day, yet feeling like he never passed a decent motion.
Previous investigations performed prior to being seen at Gastroenterology Specialist Care
included gastroscopy and colonoscopy (a few colonic polyps found and a short segment of
Barrett’s oesophagus, both unlikely to be contributing to presentation), bloods, imaging, and
breath tests (all normal).
Barry had been previously commenced on a low FODMAP diet for suspected IBS, as well as
Mebeverine, both of which made minimal difference.
On review at
Gastroenterology
Specialist Care Barry was
suspected from his
history as having
dyssynergic defecation.
Anorectal manometry,
was performed and this
confirmed the diagnosis
of dyssynergic
defecation and Barry has
been referred for bowel
retraining with a local
bowel physiotherapist.
*Not his real name
DYSSYNERGIC DEFECATION
DYSSYNERGIC DEFECATION IS A COMMON FUNCTIONAL
BOWEL DISORDER CHARACTERIZED BY IMPAIRED COORDINATION
OF PELVIC FLOOR AND ABDOMINAL MUSCLES DURING DEFECATION,
LEADING TO CHRONIC CONSTIPATION. IT IS ESTIMATED TO AFFECT
UP TO 25–30% OF ALL PATIENTS WITH CHRONIC CONSTIPATION.
THE PATHOPHYSIOLOGY INVOLVES AN INABILITY TO RELAX OR
INAPPROPRIATE CONTRACTION OF THE PELVIC FLOOR MUSCLES AND
ANAL SPHINCTER DURING ATTEMPTED BOWEL MOVEMENTS, WHICH
DISRUPTS THE NORMAL EXPULSION OF STOOL.
CONTRIBUTING FACTORS INCLUDE ALTERED SENSORY PERCEPTION,
LEARNED BEHAVIOURS, OR UNDERLYING NEUROLOGICAL
DYSFUNCTION. DIAGNOSIS IS TYPICALLY CONFIRMED THROUGH
ANORECTAL MANOMETRY. TREATMENT FOCUSES ON BIOFEEDBACK
THERAPY, WHICH IS THE CORNERSTONE FOR RETRAINING PROPER
MUSCLE COORDINATION. OTHER MANAGEMENT STEPS, INCLUDING
INCREASING DIETARY FIBRE OR REGULAR LAXATIVES CAN
SUPPLEMENT BIOFEEDBACK. EARLY IDENTIFICATION AND
MANAGEMENT CAN GREATLY IMPROVE PATIENT OUTCOMES AND
QUALITY OF LIFE.
