Dyschezia In Adults

Introduction

What is Dyschezia?

Dyschezia is a medical term used for painful defecation (act of excreting the waste of gastrointestinal tract through anal route).

Overview

The digestive system helps in the digestion of food alongside acid and other liquids of the digestive system, where numerous nutrients are either readily absorbed or prepared by the body. This allows the human body to perform various functions, like moving,, breathing, and many more.¹

The digestive system starts from the mouth and ends at the anus. There are many other organs like the stomach, intestines, liver etc. that constitute the digestive system. Once the nutrients present in the ingested materials are extracted by the body, then, the residue is referred to as faeces or waste. This waste is excreted via the anus, and the process of excreting the waste is called defecation.¹

There are many sorts of complications which make the defection process painful, and whenever one feels the pain while defecating, that situation is called Dyschezia. It is much simpler in infants as they just feel a lack of muscle coordination, so the difficulty in defecation, but pain associated with this, is not that intense.^1,3

On the other hand, adults feel high-intensity pain while excreting the faecal matter out of the body via anus. Dyschezia can be caused by many conditions like constipation, haemorrhoids, fissures, rectocele, and many other conditions of such kind. Since Dyschezia occurs because of various different types of problems, its treatment varies accordingly.²

How does Dyschezia happen?

The most common cause of dyschezia is the inflammation of the innermost lining of the largest part of the intestine, also known as the colon, and the last part of the digestive system, in which the solid waste material of the body is stored and electrolytes are finally absorbed before excretion.

Inflammation is a response of the body’s defence system against any disease-causing agent. When the body is attacked, the immune system gets stimulated and the cells which are responsible to fight against the pathogens (disease-causing agents) infiltrate the attacked site, and many kinds of mediators of inflammation come into the play and responses of inflammation become evident.^1,2

When this action occurs in the intestinal region, it affects the normal functionality of the intestine. Consequently, the process of digestion and then defecation get impacted. This leads to dyschezia in quite a few cases.

There are numerous reasons which initiate the complications in a different manner, and then most of the times those conditions converge at a common condition, i.e., dyschezia.²

Constipation

It is a condition in which the patient feels the urge to defecate; however, faecal matter does not come out of the body. This sometimes makes one exert extra pressure on the muscles of the lower abdomen, especially at the rectum region, which complicates the scenario further to develop dyschezia.⁴

Haemorrhoids

Hemorrhoid is another condition which affects the area around the last part of the digestive system, i.e., the anus. In this condition, veins around the anus and at the lower part of the rectum get swollen.

When it occurs in the rectum, it is called internal haemorrhoids while, when it exists under the anal skin is called external haemorrhoids. Both these types can be responsible for dyschezia.²

Rectocele

Rectocele is a typical condition in which the wall which separates the vagina and rectum becomes weaker because the elements that constitute the wall do not support it anymore. This leads the wall of the rectum to sag and its protrusion is found in the vaginal region. This condition is also responsible for causing dyschezia.⁵

Fissure

Fissure is a kind of muscle tear in the inner skin of the anus. At times, this might be the culprit of causing bleeding as well. This generally becomes a reason for the painful defecation, i.e. dyschezia.⁶

Pelvic floor dysfunction

The area between the hip bones and below the abdomen, in which the bladder and rectum are found, is called the pelvis. The base of this region is called the pelvic floor which helps the body in various activities like micturition (act of passing out urine), expulsion of gas, erection, ejaculation etc.

Another function of the pelvic floor is to assist the digestive system in defecation as well. Whenever the muscles of the pelvic floor lose their functionality, all the functions mentioned earlier get impaired and the defecation process is not spared either, as the patient suffers with dyschezia.⁹

Parasites

There are many types of parasites, living organisms that live on other living beings to get food and shelter; they sometimes cause diseases as well as they live in the human body. Parasites that live on the organs of the digestive system are very much likely to be the culprit of causing dyschezia.

Worms

There are several kinds of worms (scientifically called Helminths) which settle in the intestine and cause infections in the colonic region, which can get converted into inflammation followed by dyschezia.

There are other various types of parasites of the microscopic level, like fungi, algae, and bacteria etc., which live on the mammalian intestinal skin and cause dyschezia. There are different routes of complications they create to develop dyschezia at its fullest. 

Few of these micro-creatures cause irritation of the inner lining of the organs involved in the digestive system. There are certain kinds of tiny living beings which act by attaching and then invading the skin of the digestive organs, and then make clusters of the body’s own cells. This initiates the inflammatory response, and dyschezia starts.²

Hypothyroidism 

There is evidence in which hypothyroidism is found responsible for symptoms of nausea and diarrhoea, which is followed by constipation. This leads the patient to dyschezia.⁷

Diabetes

A study has suggested that there is a relationship between diabetes and constipation. It is related to the nerve damage in the intestinal region, especially, the colon part. This nerve damage decreases the ability of the intestine to push the matter in the intestine forward, and makes the stool hard.

Because of the decreased sensations, the damaged nerve rectum area feels urgency to use the loo, but evacuation is most of the times incomplete. This diabetes dependent constipation often leads to dyschezia.⁸

Antibiotics

Dyschezia may occur with a long-term use of antibiotics as well, which disturbs the balance of microbiota (special combination of microorganisms reside in a specific environment and support the immune system to fight against pathogens).

Imbalance microbiota hampers the intestine in many ways like, it may cause inflammation in the inner lining of the intestine, as the immune response becomes weaker. It may also be responsible for altering the movement of the intestine, thereby waste might not get excreted in a normal manner, and the patient might develop dyschezia.

Many of the complications which assist dyschezia to take place are majorly around the anal region. How harsh the dyschezia would be is very much dependent on the weakness or the strength of the defence mechanism or the immune system of the body.²

Signs and symptoms

Abdomen pain

Intense pain in the abdomen region is very common in patients suffering from dyschezia because the colon gets inflamed and its functionality becomes abnormal.

Partial evacuation

Dyschezia patients suffer from inflamed colon and rectum, and that does not allow the normal flow of the faecal matter to be maintained. This leads to the improper excretion of the waste.⁴

Muscle tears

Prolonged constipation can develop into dyschezia, and due to constipation patients tend to exert pressure to expel the waste out of the body. This action can tear the muscles around the anal area and can be crucial to diagnose dyschezia.⁵

Diagnosis

It is very common among patients suffering from dyschezia to not put forth the issue before the physician, and this makes it difficult for the physician to make a clear decision. This leaves the physician with an option to assess the patient’s symptoms with extreme care.¹⁰

This includes:

• The consistency of the stool. It becomes vital to examine if there is any disharmony in the relationship of the nerves and the muscles
• If there is any sort of distortion in the wall present between the rectum and vagina
• Imaging techniques are very useful in the diagnosis of dyschezia

Treatment

Sacral Nerve stimulation can relieve constipation and reduce the chances of dyschezia.

Dyschezia can be avoided or mild cases can be dealt with basic care, like.

Hygiene

If hygiene is maintained then not only dyschezia, in fact, many gut-related complications can be either tackled or even avoided. So, it is always good to wash hands before meals and brush your teeth so that the risk of disease at the entry gate of the digestive system can be minimised, and edible articles should be kept safe.¹

Fibrous diet

Diet full of fibres can help in making the condition better and in a normal person, it can avoid its occurrence, as fibre softens the stool, and maintains the motility of the gut.¹

Regular check-ups

Regular check-ups are beneficial in the diagnosis of the diseases in the early stages. For example, if someone is growing worms inside the body, regular check-ups can give a chance to diagnose it before it causes dyschezia.

Laxatives

There are various kinds of laxatives available which absorb water and soften the waste in the gastrointestinal tract after digestion.¹³

Biofeedback therapy

In this advanced instrument-based procedure, the functionality of the muscles and the nerves are restored to normal so the entire process of eating to excretion can be done in a smooth manner.^11,12,13

There are many cases in which surgery might be useful, like rectocele.⁴

Summary

Dyschezia is a medical condition in which the patient suffers from pain while defecating. This is caused by various complications, like constipation, anal fissure, haemorrhoids, and rectocele etc. All these conditions are directly or indirectly related to inflammation of the gastrointestinal tract, which develops the ailment under discussion, i.e., dyschezia.

Inflammation of the colon and rectum regions is the culprit in the majority of the cases. Once it affects the motility of the intestine constipation occurs followed by dyschezia. Intensity of dyschezia depends on the immune system of the patient, as a strong immune system can repair the damaged skin of the intestine.

Prolonged constipation is one of the early signs of dyschezia. Other conditions like blood in the faeces should be dealt with care so that dyschezia can be either avoided or at least abated. Irregular bowel movements can be felt in the abdominal region. There may be intensified pain sensations because of muscle rupture.

Hygiene maintenance and fibre intake in diet are useful in preventing dyschezia. If it takes place, then laxatives are useful in its treatment. Biofeedback and surgery are also considered depending on the severity of dyschezia.