Anismus

Anismus (also known as spastic pelvic floor syndrome, [Bleijenberg G, Kuijpers HC: Treatment of the spastic pelvic floor syndrome with biofeedback. Dis Colon Rectum 1987, 30:108-111] anal sphincter dyssynergia, [ [http://www.wdxcyber.com/ngen20.htm Help for Constipation ] ] pelvic floor dyssynergiacite journal
author = Berman L, Aversa J, Abir F, Longo WE
title = Management of disorders of the posterior pelvic floor
journal = Yale J Biol Med
volume = 78
issue = 4
pages = 211–21
year = 2005
month = July
pmid = 16720016
pmc = 2259151
doi =
url = http://openurl.ingenta.com/content/nlm?genre=article&issn=0044-0086&volume=78&issue=4&spage=211&aulast=Berman
issn = ] and dyssynergic defecationcite journal
author = Rao SS, Mudipalli RS, Stessman M, Zimmerman B
title = Investigation of the utility of colorectal function tests and Rome II criteria in dyssynergic defecation (Anismus)
journal = Neurogastroenterol. Motil.
volume = 16
issue = 5
pages = 589–96
year = 2004
month = October
pmid = 15500515
doi = 10.1111/j.1365-2982.2004.00526.x
url =
issn = ] ) is a malfunction of the external anal sphincter and puborectalis muscle during defecation. Normal defecation involves relaxation of both of these muscles. Malfunction involves their failure to relax or their paradoxical increased contraction. [ [http://www.wrongdiagnosis.com/medical/anismus.htm Anismus - WrongDiagnosis.com ] ] Anismus is a form of obstructed defecation and can cause constipation [Papachrysostomou, Maria C.; Smith, Adam N. * Functional obstructive defaecation: what is anismus?. European Journal of Gastroenterology & Hepatology. 6(11):975-982, November 1994.] . It is more common in women than in men, and sometimes is associated with sexual abuse. [LEROI A.-M. ; BERKELMANS I. ; DENIS P. ; HEMOND M. ; DEVROEDE G. Anismus as marker of sexual abuse : consequences of abuse on anorectal motility. Digestive diseases and sciences. ISSN 0163-2116. vol. 40, no7, pp. 1411-1416, 1995.] It occurs also in children, sometimes from birth.

Paradoxical contraction of the anal sphincter is fairly common and in many people it does not cause anismus.cite journal
author = Voderholzer WA, Neuhaus DA, Klauser AG, Tzavella K, Müller-Lissner SA, Schindlbeck NE
title = Paradoxical sphincter contraction is rarely indicative of anismus
journal = Gut
volume = 41
issue = 2
pages = 258–62
year = 1997
month = August
pmid = 9301508
pmc = 1891465
doi =
url = http://gut.bmj.com/cgi/pmidlookup?view=long&pmid=9301508
issn = ]

Diagnosis

Physical examination can rule out anismus (by identifying another cause) but is not sufficient to diagnose anismus. Anismus needs to be distinguished from rectal inertia, another cause of obstructed defecation and constipation. Techniques proposed to do this include the rectal cooling test.cite journal
author = Shafik A, Shafik I, El Sibai O, Shafik AA
title = Rectal cooling test in the differentiation between constipation due to rectal inertia and anismus
journal = Tech Coloproctol
volume = 11
issue = 1
pages = 39–43
year = 2007
month = March
pmid = 17357865
doi = 10.1007/s10151-007-0323-4
url =
issn = ] Other techniques include manometry, balloon expulsion test, evacuation proctography, and MRI defecography. Diagnostic criteria are: fulfillment of criteria for functional constipation, manometric and/or EMG and/or radiological evidence (2 out of 3), evidence of adequate expulsion force, and evidence of incomplete evacuation.

Anismus can be classified by type:
*Type I: paradoxical anal contraction
*Type II: impaired propulsion
*Type III: impaired anal relaxation with adequate propulsion

Complications

Complications of anismus may include fecal impaction and megarectum.cite journal
author = Real Martínez Y, Ibáñez Moya M, Pérez Mota A
title = [Megarectum and anismus: a cause of constipation]
language = Spanish; Castilian
journal = Rev Esp Enferm Dig
volume = 99
issue = 6
pages = 352–3
year = 2007
month = June
pmid = 17883300
doi =
url = http://www.grupoaran.com/mrmUpdate/lecturaPDFfromXML.asp?IdArt=459144&TO=RVN&Eng=1
issn = ]

Treatment

Biofeedback is used to treat anismus, and for this purpose it is highly effective.cite journal
author = Nolan T, Catto-Smith T, Coffey C, Wells J
title = Randomised controlled trial of biofeedback training in persistent encopresis with anismus
journal = Arch. Dis. Child.
volume = 79
issue = 2
pages = 131–5
year = 1998
month = August
pmid = 9797593
pmc = 1717674
doi =
url = http://adc.bmj.com/cgi/pmidlookup?view=long&pmid=9797593
issn = ] cite journal
author = Chiarioni G, Salandini L, Whitehead WE
title = Biofeedback benefits only patients with outlet dysfunction, not patients with isolated slow transit constipation
journal = Gastroenterology
volume = 129
issue = 1
pages = 86–97
year = 2005
month = July
pmid = 16012938
doi =
url = http://linkinghub.elsevier.com/retrieve/pii/S0016508505008851
issn = ] cite journal
author = Rao SS, Seaton K, Miller M, "et al"
title = Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation
journal = Clin. Gastroenterol. Hepatol.
volume = 5
issue = 3
pages = 331–8
year = 2007
month = March
pmid = 17368232
doi = 10.1016/j.cgh.2006.12.023
url =
issn = ] However, when anismus occurs in the context of intractable encopresis (as it often does), resolution of anismus may be insufficient to resolve encopresis. For this reason, and because biofeedback training is invasive, expensive, and labor intensive, biofeedback training is not recommended for treatment of encopresis with anismus.

Other therapies, such as botulin toxin type-A [Botulinum toxin type-a in therapy of patients with anismus. Journal Diseases of the Colon & Rectum. Publisher Springer New York. ISSN 0012-3706 (Print) 1530-0358 (Online).Issue Volume 44, Number 12: 1821-1826. December, 2001] injections into the affected muscles have been considered. Historically, the standard treatment was surgical resection of the puborectalis muscle, but this has been found to be of no value.

References