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Abdomino-anal Dyscoordination in Defecatory Disorders
Sushmitha Grama Srinivasan1, Anjani Muthyala1, Mayank Sharma1
1Division of Gastroenterology and Hepatology, Department of Medicine, Rochester, Minnesota.
Summary
Abdominal muscle coordination is altered in women with defecatory disorders (DDs), showing dyscoordination during evacuation and muscle activation. These findings highlight potential issues in abdominal muscle function contributing to constipation and defecation difficulties.
Area of Science:
- Gastroenterology
- Pelvic Floor Function
- Physiology
Background:
- The role of abdominal muscles in normal defecation and defecatory disorders (DDs) remains largely unknown.
- Investigating these muscles is crucial for understanding defecation mechanisms and dysfunction.
Purpose of the Study:
- To investigate the contribution of abdominal muscles to normal defecation.
- To identify disturbances in abdominal muscle function associated with defecatory disorders.
Main Methods:
- Simultaneous measurement of anorectal pressures (manometry) and abdominal muscle thickness (ultrasound) in healthy women and women with DD.
- Assessment during various maneuvers including hollowing, squeeze, evacuation, and Valsalva maneuver.
- Principal component analysis (PC) to correlate muscle activity and pressures with defecatory function.
Main Results:
- Women with DD exhibited altered rectal and anal pressure responses during evacuation and different abdominal muscle activation patterns during muscle squeeze.
- Specific correlations between transversus abdominis muscle thickness changes and defecation maneuvers were observed in DD.
- A principal component (PC3) derived from anorectal pressures and muscle thicknesses during evacuation was significantly associated with prolonged rectal balloon expulsion time (BET), a marker for DD.
Conclusions:
- Findings suggest three potential disturbances in DD: aberrant abdominal muscle activation, general abdominal muscle dyscoordination, and abdomino-anal dyscoordination.
- These dysfunctions may contribute to the pathophysiology of defecatory disorders.
- Further research into these coordination issues could inform therapeutic strategies for constipation and DDs.
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