Dyssynergic Defecation (or…when the poop just can’t get out)


I’ll admit it… I like treating pooping problems. I know that grosses some people out, but it’s true. I think it’s because bowel problems really really impact people’s lives. I mean, pooping is a super basic human activity–so when it’s not working the way it should, it’s really awful.

I have recently had quite a few patients who are having difficulty evacuating their bowels. Now, there are multiple reasons why this could occur (I know, I’ve written about constipation a lot already, see here for evidence)–but today, we’re going to chat about one in particular, dyssynergic defecation or sphinctor dyssynergia.

What exactly is dyssynergic defecation? 

Basically, your pelvic floor muscles work with your colon reflexively. When your colon is contracting to push the poop out, and you are sitting on the toilet ready to empty your bowels, the muscles should relax and open to allow this to occur.  Sometimes, this relationship becomes dysfunctional, and basically, you think you are pushing and relaxing the sphinctor muscles, but instead, the muscles are contracting and closing the sphinctor. I know what you’re thinking– Jessica, I would know if I were actually contracting my muscles instead of relaxing them while I poop. But, no, you wouldn’t. In fact, many patients are shocked when I show them the actual coordination of their muscles.


Typically, incoordination of the pelvic floor muscles is paired with poor coordination of the abdominal muscles, and often impaired sensation of the rectum. Dyssynergic Defecation is diagnosed typically by an anorectal examination, and anorectal manometry/defecography testing (like this, with an MRI, or by assessing muscle activity with EMG while the person attempts to expel a balloon, or other testing options)

Why does it happen? 

Dyssynergic defecation is very common in people who have constipation. In fact, this review suggested that close to 40% of people with constipation have this incoordination pattern. There are several factors that can contribute to dyssynergic defecation. This review estimated that close to 30% of adults with dyssynergic defecation patterns had constipation as children, and found that 46% had frequent straining to empty hard stool. But there are other factors that can contribute as well, such as:

  • pregnancy
  • traumatic injury
  • low back pain
  • history of sexual abuse/trauma
  • poor behavioral habits related to bowel health
  • nothing (like many other things, we sometimes just don’t know why it happens)

What are the signs and symptoms? 

As we discussed previously, dyssynergic defecation is extremely common amongst those struggling with constipation (typically meaning < 3 BMs per week, as well as symptoms of abdominal discomfort, bloating, and/or difficulty emptying bowels). This article looked at the most common reported symptoms of those with dyssynergic defecation, and found that many experienced the following:

  • Excessive straining to have a bowel movement
  • Feeling of incomplete evacuation after a bowel movement
  • Abdominal bloating
  • Frequent hard stools
  • Frequently utilizing digital maneuvers to empty stool (this means, using a finger to either help pull stool out of the rectum, or using a finger to press inside the vagina to help empty)

What can you do about it? 

The great news is that men and women (and kids too!!) with a dyssynergic defecation pattern can respond very well to conservative treatment! Pelvic physical therapists are typically the providers of choice when it comes to helping people with these problems, and work closely with GI and Colorectal Physicians to help these men and women. Treatment typically involves a few different components:

1. Developing amazing bowel habits. You know that has to be first on my list. If your bowel habits are not stellar, we can try to help your muscles all we want, but you will still have difficulties emptying. So, first things first, we need to make sure your dietary habits rock, you have a great bowel routine, and you know how to sit on the toilet in the most optimal way. Wondering what that toilet position is? Check out this sort of funny, mostly weird video by my favorite potty comedians and stool developers (pun intended), Squatty Potty.

2. Surface EMG Biofeedback training to improve muscle coordination: Biofeedback training uses surface electrodes placed at the anal sphinctor muscles and the abdominal muscles to identify the type of pattern a person uses to expel a bowel movement. Once we identify the pattern you currently use, we can work together to improve the pattern so that your sphinctor muscles relax when you generate abdominal pressure to empty your bowels. Seems pretty basic, right? But the right biofeedback training can make a HUGE difference–and the current research really supports this treatment for anyone with this problem. (See this article, this one, that one, and this one!)

3. Making sure your pelvic floor muscles are strong, FLEXIBLE, and well-coordinated. So, we’ve talked in detail about the pelvic floor muscles on this blog. Remember, we all want muscles that can contract AND relax. And, for dyssynergic defecation patterns, the relaxation component is extremely important! Often times, people who have difficulty relaxing their muscles to have a bowel movement tend to have tender, overactive pelvic floor muscles to begin with. So, treatment will also focus on improving awareness of the pelvic floor muscles, learning to relax the muscles (dropping and lengthening them), and often will include some manual therapy (yes, internal vaginal or rectal) to help reduce the tenderness and improve the mobility of the muscles.

4. Balloon retraining. People love hearing about this one… but it really is an awesome and effective treatment for so many men and women!! (Research supports it also– see here and here!) This treatment basically uses a small balloon that is attached to a catheter and is inserted into the rectum, and slowly inflated. Often times, people with dyssynergic defecation patterns have decreased sensitivity in the rectum, so they will not feel the presence of stool (or a balloon!) in the rectum when they typically should. Based on what we find initially, we can use the balloon to improve the sensation in the rectum. We can also use a slightly filled balloon to work on proper expelling techniques. I know what you’re thinking, Wow Jessica, this sounds like a super fun and awesome treatment. I know, but honestly, it’s very very helpful for people who need it!

Now, this just scratches the surface in terms of what all we pelvic PTs do to help with dyssynergic defecation. But, I wanted to get the conversation started! This tends to be a topic many people don’t talk about… in fact, I have had men and women travel SO far just to get the initial diagnosis! And, I need that to stop… hence this blog post today. Lastly, if you are having problems with constipation and think you may have this problem– Go see a GI/Colorectal Physician! Honestly, make an appointment today! And, contact your local pelvic PT. If you live in Atlanta or the surrounding area, give me a call! It’s time to get your bowels back in order (or even in order for the first time!).

I always look forward to hearing from you! So please, ask any questions or make any comments below!!

~ Jessica

You don’t have to just deal with your bowel problems! CLICK HERE to schedule a virtual consultation with our team today to start feeling better!

166 thoughts on “Dyssynergic Defecation (or…when the poop just can’t get out)

  1. Hi Jessica…Can pelvic muscles uncoordination occur at the end of bowel movement? Its like at the beginning, the bowel movement is normal..but at the end i feel that i m not done yet and no matter how hard i strain…it doesnt come out. Many times i feel that i m not done yet..but later its just gas that is stuck there…and that too doesnt come out. I drink 2 litres of water in a day..also intake of fibre is proper in the form of fruits and vegetables.
    Thank you

    1. Hi Dharmesh! Absolutely, this can happen. I see this as a common complaint. The muscles basically don’t like staying open, so they’ll close and people will feel incomplete evacuation of the stool or difficulty with gas. If you haven’t, I would recommend seeing a pelvic PT for evaluation to see if they could help you! All the best in your healing!

  2. Hey Jessica!

    Great article I feel like your description of this checks off all of the symptoms that I have. My colonoscopy was clear minus some internal hemorrhoids that I always thought was causing me to have to push and strain so hard to have a bowel movement. But now I feel like those are a result and not the cause.

    Would the severity of this condition possibly get worse as the day goes on? I am able to have 1 super easy bowel movement in the morning but as the day goes on I constantly feel like I need to go but am unable to. I spend so much time on the toilet and it is having a huge negative impact on my life. Could this also cause narrow, pencil thin stools? All the doctors I’ve seen seem to believe I have tenesmus, but have only recommended I take more fiber. Unfortunately this makes me feel worse and have to strain even harder to have a bowel movement. If you have any advice or know of any doctor in the Washington DC area that would be great. I’ve been suffering through this for years and I am desperate for some relief. Thanks again!

    1. Hi Brendan, I’m sorry you’re dealing with this! We actually see this pattern of worsening symptoms as the day progresses very frequently. As the muscles become irritated and contract more, this leads to increased tensioning, which can cause very narrow stools. I think seeing a pelvic floor PT could be a good place to start. In the DC area, I frequently refer to Pany Nazari and Lauren Trosch. They’re both excellent clinicians! All the best, Jessica

    2. Omg I am mind blown. This is me exactly. I get the urge and have one normal movement and then I feel like I still have to go it’s very difficult to get the rest out and it’s narrow. I have been in PT for six months which is finally got my pelvic floor to relax because it was in a constant tense state but now we can’t get this finishing part it’s miserable and makes my life not worth living!

      1. I feel the exact same way. I’m on my 7th pelvic floor therapist and really don’t know what to do after this. I was offered an ostomy. I’m avoiding it now, but that might be my only option. Good luck to you.

  3. I absolutely enjoyed reading this article and found it very informative. Mega props to those responsible for the squatty potty video too. Thank you so much for this article!

  4. Hi Dharmesh! I read you comment I have the same problem Mnay times it takes a long time ,
    Sometimes it takes an hour or more just to get things moving ,,,,,,,,It goes lower and lower ,ito the rectum ,,Sometime I am able to go a bit but it’s always incomplete ,,,,and it is very painful ,,Even when I add force ,,and push it will not come out ,,,,I know I should not sit there for such a long time ,But the urge to go is so overcoming that I cannot get myself to get off the toilet ,,Sometime if I just sit there and strain for a while ,I can get out a little more but again always incomplete ,,I have gone to a least ,7 rectal surgeon as well a a couple of gastro doctors ,,and they all give me different sugestions ,,,,The suggest colace ,mirilax ,metamucil ,senna you name it Nothing works ,,,,I tried to change my diet or add a lot of water also but ,,that does not help much either ,,,

    Looking deparately for an answer for this problem This is painful and has been going on for at least 7 to 8 years

    Very hard to live with this condition ,I always feel like I have to go to the bathroom ,,and it is hard to live with this problem ,,,,,,,Anyone have alternative answers ,,None of the doctors have an good solution ,,,,

    Yours truly


    1. Hi Sandy, I’m so sorry you’re struggling. Have you worked with a pelvic floor PT yet? That could be very useful to get a different perspective on your condition. Happy to help make a recommendation for you! All the best, Jessica

  5. Can this occur suddenly instead of gradually, as well as at a relatively young age (I’m still in my teens)? I remember that about three years ago I was abruptly unable to defecate without strain, and thus have been to many doctors, resulting in a colonoscopy as well as an MRI. Everything was proclaimed to be in good health, and it was declared that my inability was merely psychosomatic. Though even after three whole years, the problem persists.

    1. Hi JD- First, I’m so sorry for this delay in responding! Bowel problems in children and teens is also very common. I would really encourage you to see a different physician, perhaps a pediatric GI specialist (if you’re under 18) or a Colorectal specialist (if you’re over 18) to evaluate you. They can perform anorectal manometry for you which will identify dyssynergia. Option 2 would be to seek out a pelvic floor physical therapist who can evaluate this for you in clinic and help you figure this out. If you are under 18, I would really recommend sharing this article with your parents to help them potentially understand what is going on and support you in your journey. Sorry again for the delayed response! Best of luck in your healing! ~ Jessica

  6. Hello Jessica; I am a clinical psychologist working in Sarasota, Florida. I have been treating a 15 year old male who is often ostracized at school due to recurrent fecal odor and the soiling of himself (even during class). Most people had expressed concerns related to potential past issues of abuse, his current familial problems and his suppressed feelings of anger. Reading your blog presents an alternate hypothesis. have you had and/or treated teenagers with this type of problem? How common might this problem be for adolescents? Thank you for your efforts. I look forward to your repsonse(s).

    1. Brad, I’m so sorry for missing your comment and not responding!! I actually have treated children and teens with difficulties like this. One of the common problems (different from this one) for kids is constipation with encopresis and fecal soiling. What happens in that case is that the stool backs up in his rectum, stretches it significantly, then looser less digested stool seeps around the stool leading to accidents that he doesn’t feel nor notice. It’s a major problem. If he hasn’t been evaluated by a pediatric GI provider, I would strongly recommend that. They can quickly find out if this is the case. Dyssynergia, if this is the problem, can also be easily diagnosed with anorectal manometry. I hope this is helpful, and again, apologize for the delay. Feel free to e-mail me at jessica@southernpelvichealth.com if you’d like to discuss further! ~ Jessica

  7. Hi Laura, I am 13 and I get constipated often.
    When I overcome this, i poop for about 2 days normally, one day a little, then the next a tiny bit.
    I think I may have this because on the day I poop a little, the stool is soft, but it doesn’t come out no matter how much i push.
    I poop normally without this pelvic floor thing, but on the 4th day, it just doesnt all come out.
    What do I do?

    1. Hi Hannah, I’m so sorry you’re dealing with this! Pooping problems are so hard to deal with. If you’re 13 years old, please talk to your parents about this, and tell them you want to see a doctor to be evaluated. Constipation problems in teens is a little different than adults, so doctors who know about kids (in this case, a pediatric GI doctor) are the best ones to see! ~ Jessica

  8. Hi what I am reading from you and the comments sounds like me. I start the day with a poop and by the end of the day I need another but I just cannot push it out. Change me position will be the first thing. I am seeing a specialist soon, so hopefully I can get some direction with this. Over time it is getting worse.

    1. Sorry for the delayed response. I hope you’re able to see a good provider to help you with this! I’m happy to help offer some guidance if you need it! ~ Jessica

    1. Yes! Lots of great PTs in NYC. Amy Stein’s group, Beyond Basics Physical Therapy is great. I also really like Stacey Futterman’s group 5 Point PT and Kara & Erika’s group, Solstice PT. All amazing clinicians and great practices! Good luck in your healing journey (and sorry for the delay!!) ~ Jessica

  9. Hi jess,

    my problems started about 2 week ago coincidently on the back of a 50 mile bike ride I went on, I’m not an avid cyclist but due to the current goings on in the world I have taken up riding recently. after the ride I suffered with bad saddle sourness and pain in the number 2 area which subsided a day or 2 later, since then I have managed to go every day but the natural urge that you get when its time to go seems to have disappeared and I’m finding I have to go and sit on the toilet and force a bowel movement rather than a naturally occurring one, my question today is could there have been potential nerve damage from the saddle that can impact on the pelvic floor and related nerves to the contracting muscles?

    1. This sounds nerve related to me, and perhaps muscles involved as well. I would encourage you to see a pelvic floor PT locally for evaluation to get a closer look at what is going on and help you get this improved! Best of luck in your healing journey! ~ Jessica

  10. Hi Jess,
    I am 26 years old, constipated almost everyday and have been suffering from severe haemorrhoids and fissures for the past 3 months. A doctor put me on laxatives for this entire 3 months period to make sure my stool remains soft and the fissures heal. It has healed 80% now, but the fissure and haemorrhoids have reached a point where no medicine/ointment is working on them. Also because of the extreme pain that I experienced everyday for the past 3 months, I have now gotten used to a very weird habit. I get this urge to poop after which I can feel the poop inside my anus, but I can’t get it out on my own even if I’m squatting properly.
    Now since I cannot strain at all because of the fissure and haemorrhoids, I have to use a rectal douche to push about 30 ml of water inside my anus, following which the stool comes out along with the water immediately. This makes me feel like I’ve lost my natural ability to use my anus muscles to poop and it stresses me out too much. I am from India and no doctor here is able to understand my situation. They simply keep giving me laxatives and ointments to heal the fissure, which is also not working. I am really frustrated, depressed and hopeless since the last 3 months. It has affected my daily activities and mood very badly and any help from you would be really appreciated even if it means consulting you virtually.
    PS: Right now my diet is good with a lot of fibrous vegetables and fruits and at least 4 litres of water each day. Avoiding spicy food for now because of the fissures.

  11. I have had problems with bowel movements for 22 years – possibly more. 10 years ago, I had a rectocille repair and now it’s as if there’s a holding area down there and I have to push the back of my vagina to get the feces to come out. Have you heard of this? Any recommendations in the greater Nashville area? Preferably north of Nashville. Thanks

    1. Hi Joyce! I’m sorry you’re dealing with this Pushing at the back of the vagina to empty is common, especially for people who have rectoceles. Seeing a pelvic PT would definitely be helpful. I don’t know anyone personally in Nashville but did find Archer Physical Therapy, and they seem knowledgeable. Check out the options at pelvicrehab.com and see what you think.

  12. Hello, can you help me? I live in NYC and having what may be dyssynergic defecation issues. I just had a colonoscopy that showed nothing serious, just a redundant colon/tortuous colon, whatever that is. But having real problems affecting my quality of life. I am wondering if this may also be caused by the SSRI I take, Celexa. Would Amy Stein’s group, Stacey Futterman or Solstice PT be able to help? Terrible.

    1. Hi Karl! Happy to help. Celexa does have constipation as a side effect, so this could be a part of it. All 3 PT clinics you mentioned are great. Have you seen anyone yet? One of my PTs is also licensed in New York, and she’d be happy to see you via telehealth if you’d like. Feel free to email me- jessica@southernpelvichealth.com

  13. Hi Jessica, I have an adult severely disabled daughter. She suffers from issues with her bowels. Constipation which has caused fissures & hemorrhoids. Yet when she is able to have a bm I can tell she can’t completely evacuate. She’s nonverbal and uses a wheelchair so it’s complicated. The latest GI doctor has put her on Linzess but she’s still not completely evacuating. I end up giving her a glycerine suppository to help her. Would a pelvic PT be able to help her even with all the disabilities. I’m so tired of her being ignored because she can’t communicate what she’s feeling. I try to do so for her, but I’m not sure what she’s feeling. Thank you.

  14. Hi Jessica, I have had problems for a while with constipation. I have been to the ER, seen my GI (several times), had I think every test possible and get nothing for an answer. I have been told I have a lazy colon but it has become more than lazy. I have looked all over the net to try and find someone who can help me! I have some friends that are so worried they have been researching drs as well. I no longer can go on my own, I have to do a laxative to go and never go fully! I am now drinking regular Epson salt mixed with V-8 juice in order to go to the restroom. I feel bowl moving through my colon and constantly have pain on my left side which drs have told me is nothing there. I feel it so I know something is going on. My husband is so worried about me he thinks I am going to have to have a colostomy bag at some point. My stomach is always swollen and at times looks like I’m pregnant. I feel bad most days anymore and don’t want to do anything. I am hoping you have some insight into what might be going on or point me in the right direction. I just really need some help from a dr that actually cares about more than what tests they can do for money. I’m sorry I have no trust or hope in drs anymore. Please help if you can!

    1. Hi Michelle, First, I am truly sorry for the delay in my response! As you may have seen, I somehow missed my comment notifications more recently! I’m sorry you’re dealing with such severe bowel problems. Where do you live? I have connections with pelvic floor physical therapists, and could find you a good one to start connecting with. Skilled ones can often help to guide you to the best medical providers in the area as well who would be able to help! Feel free to e-mail me at jessica@southernpelvichealth.com and I’m happy to help!

  15. I do have all the symptoms. I can tell one or some of my muscles are doing the opposite what i intend tho. And in fact my butt contracts tightly when i need to pass gas & I have to push hard to get any air out. I have been diagnosed with rectocele. Is it normal to have this condition along with rectocele? I have severe nerve damage & wondering if muscles behaving opposite is just an new manifestation of that neuropathy.

    1. Hi Mindy, I’m sorry you’re dealing with this! Rectoceles can go very hand in hand with dyssynergia and constipation. Working to restore the muscle coordination and mobility can often help spread the load regarding pressure and improve what you’re feeling from the rectocele.

  16. Thank you for this article! I’ve been dealing with pudendal nerve issues & pain for a year now after my last c-section. In addition to pain I am having issues after I have a bowl movement. I’ve been upping the fiber to stay regular/soft but I don’t think I’m getting it all out- like there’s just *a little* bit left because I will wipe clean and a short time later go back and if I wipe…I’m not clean anymore 🙁 There’s never any leakage in my underwear, but it’s still very disheartening.
    My question is: can this be caused by the pelvic floor muscles not working correctly? I have a hypertonic pelvic floor if that is relevant. I doubt it’s a sphincter issue since I never have leakage on days I don’t have a BM.
    I just restarted pelvic PT and will ask about biofeedback but am curious what your thoughts are.
    Thank you!!!!

    1. Hi Michelle,
      I’m so sorry for the delayed response! Like you see in the comments above, I somehow missed the comments coming in over the past 2 months! This situation is a little more complex, with your history of pudendal nerve problems post cesarean, and resulting pain. The bowel cleaning problem can definitely be related to your hypertonic pelvic floor, and what is happening at the sphincter. I think pelvic PT should be able to help you with that. I would make sure they’re addressing your abdomen, but also the pelvic floor muscles from a vaginal and rectal standpoint. Hopefully now you’re in a better place, but feel free to reach out if you have more questions or need more support! ~ Jessica

  17. This was the first time I’ve read anything related to these issues and found it very helpful. I am 35 years old and have always had a hard time going to the washroom. But lately, after having my two sons, I’m having more trouble than ever and am horrified to even bring it up to anyone. It is normal for me to only poop once every seven days or so. But now that it’s stretching longer and longer I am incredibly uncomfortable. Thank you for this information and for not making it an uncomfortable topic.

    1. Thanks for your comment Kirby! I’m sorry you’re dealing with problems like this! If it is still persisting, definitely talk with a GI or colorectal provider. They are an important first step to see what is going on medically. After that, a pelvic floor physical therapist can be a crucial player in helping the bowels move better!

  18. I was sexually assaulted for over a month and since then I cannot feel my poop come out or go to the bathroom normally. I get so backed up that it’s hard to pee and I start throwing up. How do I talk to my doctor about this issue when he won’t see me until I have my colonoscopy and all the medicine he has given me as a prep hasn’t work and they keep having to reschedule the colonoscopy? Frankly I have given up and use laxatives off and on when I get to the point of extreme pain, bloating and vomiting. It’s really effects my life and self-esteem. Thank you for your time and I appreciate your blog.

    1. Hi Lia,

      I’m so sorry for this delay in responding– I had an issue where I wasn’t seeing the comments coming through, so missed like 2 months worth of comments!! SORRY again.

      First, I am so sorry you have been dealing with all of this. Sexual assault is such a pervasive problem, and it breaks my heart that you went through that. Any trauma can be very impacting to the body, particularly around the pelvis. If things have been getting very backed up, I would look into seeing a different doctor who can evaluate and help you. A GI or Colorectal doctor could be a good option to see if your primary provider has not been helpful. If you have some support from a counselor or psychological professional, that would also be a good person to work with. They may be able to help advocate for you to get additional help. I realize this comment was posted a while back, and things may be very different for you now, but if you are still struggling, feel free to e-mail me and I’m happy to offer more guidance! jessica@southernpelvichealth.com

  19. I never comment or anything on stuff like this. Though this really helped me, it was funny, interesting, and i just wanted to thank you!

  20. I am so mind blown because this is exactly me. I’ve been dealing with this problem for so many years and was just recently diagnosed with a non-relaxing pelvic floor. My physical therapist was able to finally get it to relax and stay relaxed but after I get the urge once and go I can’t get everything out and then if I do it’s very skinny. Looking for help

    1. I’m so sorry Amanda! These problems are way more common than many people think! Has your PT specifically worked with you on coordination training when emptying your bowels? Have they tried doing sensory balloon training? These could also be very godo interventions to try to help you!

  21. I have been unable to get ANYTHING out of my bowels without first irrigating 1-1.5 l water in there (enema bucket). It’s been over 3 years now and had a sudden onset (from one day to the other it just didn’t work).
    Stool is not hard or compacted, I even can’t defecate without said enema when I have diarrhea and sometime the water that I flush up there is not even coming out completely.
    Had tests and colonoscopy done but everything looks to be in order.
    It’s not fun.

    1. Sa Wa, I’m so sorry for the delayed response! I’m sorry you’re dealign with this kind of problem. It sounds like you may have a problem with the sensory function in the rectum. I would recommend seeing a different Colorectal specialist physician who can evaluate you. Additionally, if you’re open to all sorts of treatment, sensory balloon training may be a great option for you to improve rectal sensation. There are pelvic floor physical therapists who do this, but you’ll need to call and ask to be sure! Hope this is helpful! ~ Jessica

  22. Hi Jess,

    Thank you so much for writing this article! I shared my condition with my doctor and she said that you may have motility issue and go to bathroom only when you really have to go. But I think what you’ve written, describes my condition better!

    I’ve had this problem for most of my adulthood, and it’s been 25 years now. I don’t recall having common constipation more than once or twice in that period. I come from Asia and used a WC toilet in my childhood. 25 years ago, my family migrated to UK and I was introduced to the toilet seat and I believe I’ve had this problem ever since. Basically, I have a normal bowel movement almost every morning, in the first push what comes out is either a single snake shape or a bit thinner than that. Then I sit there for few mins and the next installment is thinner and smaller in overall size. This pattern continues for one or two times more. 90% of the time I leave the bathroom with the feeling of incomplete defecation. Once in a while it’s normal Sausage shaped and I am done rather quick. I bought a Squatty Potty but still not satisfied. Also, my stool is never hard or too soft and looks normal.
    Do you think that some irreparable damage could’ve been done because of the duration of this condition i.e. 25 years? Is something I can do on my own to fix this issue?
    Could you please recommend someone in Fairfax VA (or Northern VA)? Also, is it something dangerous?


    1. Hi Ray, First, I am so sorry for my delayed response! I had been missing some of these comments coming through!! What you’re describing really does sound like dyssynergia, but obviously, I am not examining you, so cannot say for sure. Sometimes people will have a combination of things going on, and this is why being evaluated is so important. I do think that working with a pelvic floor PT could be a great option for you. In northern VA, I often refer to Pany Nazari or Lauren Trosch. They are both fabulous and do a great job with their patients. I would give that a try, and they can also help you determine if you need any other additional medical intervention. Wishing you all the best in your journey! ~ Jessica

  23. Hi and thanks so much for your article. Local primary care doctors’ eyes just glaze over when I explain what I’m experiencing, which is exactly this. I actually had one the other day who patiently waited while I explained dyssynergia and the precise behavior of my GI system, Then with a wave of his hand said “okay well I heard all that but anyway…”

    Like others here, my basic question for you is who locally can help with this? I’ve been fighting it for years and it’s getting so bad that I have to micromanage with mega magnesium doses every night, defining my life way too much. Failing starts the countdown clock to emergency. Who near Seattle can help? (I’m actually in the San Juan islands, but that’s hopeless when it comes to medical care.)


    1. Steve, I’m so sorry I missed your comment!! If you are still struggling, I’m happy to help you find someone to help! Holly Tanner is a colleague and friend and owns Flow Rehab in Seattle. Her practice does a great job, and I would highly recommend! Hope that helps!

      1. Thanks, Jessica! I just had my first PT with someone at Island Hospital in Anacortes who does pelvic floor and speaks the language… encouraging. Going to visit weekly for a while and see how it goes; doctors have been completely uninterested. The latest just said “have you tried Metamucil?” So painfully clueless… this has been worsening for years and that breed of clinicians just tunes it out.

        By the way, I fit one of the profiles you mention in your article. Constipation ever since childhood, for which I can probably thank my Bostonian mother who, for some inexplicable reason, set a 5-minute timer. Only child, no bathroom shortage… but she had that weird obsession. Never relaxed in there, ever.

  24. Hello,

    Im11 weeks post partum and got a rectocele at 2/3 weeks post partum however I was fine with BMs until around 8 weeks post partum. All this time I’ve been using stool softeners. One day I had a very large stool and then after that I’ve had to take glycerin suppositories to expel. I just don’t know that the stool is even going down. Then I feel a heaviness more in my vagina and realise stool is there and have to take a suppository. It’s so distressing and with young children I can’t sit on the toilet / spend time on my bowels. Will this never clear up? I suspect I have a hypotonic pelvic floor (over active?) when I gave birth they couldn’t get a suppository in I was so tense but that seemed to get better. Should I stop taking stool softeners as I’m thinking maybe my stool is too soft for my rectum to recognise? Will using glycerin suppositories cause long term damage? Thank you so much for your help!

    1. Hi Emma,
      I’m so sorry you’re dealing with this! It’s hard to give specific recommendations without evaluating you. Honestly, I would suggest getting in with a pelvic PT sooner rather than later so they can help you figure out what is going on with the muscles around your anal canal, and discuss your bowel situation in a lot more detail. This should be able to give you some answers more specific to you and help you get a plan to get this improving! Hope this is helpful! ~ Jessica

  25. Hi Jess,

    So helpful! I have had a long road since childhood constipation and urinary incontinence that continue to grow worse. I have dyssnynergic defecation, an imbalance of rectal to anal pressure at rest, failed the balloon expelling test, and maxed out in the ballon inflation with no sensation. Another oddity is I am unable to develop the urge to have a BM unless standing up. Seems to be the only way for the stool to descend into my rectum. I’m wondering if you have ever heard of anything like this. It is significantly controlling of my life. I cannot afford traditional biofeedback and 3 rounds of pelvic floor PT have failed. My muscles don’t relax well so more kegels seems to do more harm than good. I have been using a pelvic wand lately (vaginally and rectally), which seems to help loosen slightly but I still have to stand to get things moving. Any thoughts or suggestions? I’m in Atlanta, 24-year old female. I would appreciate any and all help!

    1. Hi Amy, I’m so sorry you’re struggling with this! Have you worked with a PT to do sensory retraining for your rectum with balloon biofeedback? It sounds like there could be a sensory component, paired with some challenges related to muscle function. Kegels would not typically be recommended in this case– more focused relaxation of the muscles. I know you mentioned seeing pelvic PTs in the past, but would you be open to getting another opinion? My practice is in Atlanta, and we’d be happy to help you. We offer free 15-min phone consults for people considering care locally, so I’m happy to chat with you more about our approach. Sounds like it may be a little different from what you’ve done in the past. Feel free to e-mail me at Jessica@southernpelvichealth.com and I’m happy to help!! ~ Jess

Leave a Reply