On anorectal manometry, which finding would suggest a dyssynergic pattern that may guide therapy toward biofeedback?

On anorectal manometry, which finding would suggest a dyssynergic pattern that may guide therapy toward biofeedback?

• A. Normal rectal sensation with intact sphincter.
• B. Reduced sphincter pressures only.
• C. Paradoxical anal contraction with attempted defecation.
• D. High anal resting pressures with no leakage.

Answer: (C)

Dyssynergic defecation is a coordination problem where the pelvic floor muscles and anal sphincter don’t relax properly during attempted defecation. On anorectal manometry, the key sign is paradoxical anal contraction (or failure to relax) when the patient tries to bear down. This indicates the sphincter and pelvic floor are contracting instead of relaxing in response to pushing, making stool evacuation difficult. Recognizing this pattern helps guide therapy toward biofeedback, which trains the patient to relax the pelvic floor and coordinate abdominal pressure with anal sphincter relaxation to improve evacuation. Other patterns, such as normal sensation with intact sphincter, reduced sphincter pressures, or high resting pressures with no leakage, reflect different issues (normal function, sphincter weakness, or hypertonicity at rest) and do not indicate dyssynergia.

Dyssynergic defecation is a coordination problem where the pelvic floor muscles and anal sphincter don’t relax properly during attempted defecation. On anorectal manometry, the key sign is paradoxical anal contraction (or failure to relax) when the patient tries to bear down. This indicates the sphincter and pelvic floor are contracting instead of relaxing in response to pushing, making stool evacuation difficult. Recognizing this pattern helps guide therapy toward biofeedback, which trains the patient to relax the pelvic floor and coordinate abdominal pressure with anal sphincter relaxation to improve evacuation. Other patterns, such as normal sensation with intact sphincter, reduced sphincter pressures, or high resting pressures with no leakage, reflect different issues (normal function, sphincter weakness, or hypertonicity at rest) and do not indicate dyssynergia.