Pelvic floor physiotherapy for dyssynergic defecation/obstructed defecation syndrome/fecal evacuation disorders

Background: Pelvic floor dyssynergia is an inability to relax the pelvic floor muscles during defecation. Successful defecation requires increased intra‐abdominal pressure combined with relaxation of the pelvic floor muscles. An inability to coordinate this action often results in chronic constipation, painful bowel movements, and excessive straining. The purpose of the case report is to describe the successful pelvic floor physiotherapy treatment of a patient with long‐standing constipation caused by pelvic floor dyssynergia. Study Design: This is a case report revealing the pelvic floor physiotherapy interventions used to treat the patient, the outcome of the treatment, and discussion and implications for current and future pelvic floor physiotherapy management of constipation caused by pelvic floor dyssynergia. Case Description: The patient was 38 years female complaining of chronic constipation existing since 15 years. The pelvic floor physiotherapy interventions included neuromuscular re‐education using electromyographic biofeedback, tactile biofeedback, and instruction regarding coordination of abdominal muscle contraction for increased intra‐abdominal pressure combined with pelvic floor muscle relaxation. Outcomes: The patient attended 10 pelvic floor physiotherapy sessions over a 8‐week time frame followed by 2 phone consultations. At time of discharge the patient was having normal bowel movements 80% of the time, was not using laxatives or enemas, reported no pain with bowel movements, improved his Obstructed Defecation Syndrome Score by 11 points and had returned to work. Discussion: This case report discusses the pelvic floor physiotherapy management of a man with pelvic floor dyssynergia causing chronic constipation. Interventions included biofeedback therapy and muscle retraining resulting in normal defecation.