Gastroenterology clinics of North America
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Dyssynergic defecation is a common clinical problem that affects half of patients with chronic constipation. In many patients, there is a significant overlap with slow transit constipation. The chief underlying pathophysiologic mechanism is a failure of rectoanal coordination. ⋯ Controlled trials are under way to evaluate the efficacy of biofeedback therapy. Meanwhile, it is possible to treat most patients by using neuromuscular conditioning and biofeedback therapy. Further refinements in diagnostic criteria and in rehabilitation therapy programs should facilitate better diagnosis and treatment of patients with dyssynergic defecation.
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Functional anorectal and pelvic pain syndromes represent a diverse group of disorders that affect the quality of life and about which many physicians possess little understanding. Nongynecologic causes include levator ani syndrome, proctalgia fugax, and coccygodnia, which can often be distinguished by careful history and physical examination. In women, chronic pelvic pain may arise from the uterus, cervix, ovaries, or from endometriosis and pelvic adhesions. This article reviews these diverse disorders and the approach to diagnosis and management.