# Paradoxical Sphincter Contraction - not a genuine condition?



## tummyrumbles

Paradoxical Sphincter Contraction may not be a genuine condition. One study suggests that paradoxical sphincter contraction also occurs in healthy people, and can be a result of embarrassment during testing.

Surgery is not recommended for idiopathic constipation as the cause is not known.

According to one study most patients with idiopathic constipation have normal colon transit times. Studies on idiopathic constipation often contradict one another.

http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2982.2002.00304.x/full

Paradoxical sphincter contraction is rarely indicative of anismus

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1891465/

A study of colonic transit time in patients with chronic idiopathic constipation

http://www.iagh.org/Portals/44fa7561-56f7-47e4-a228-477ca071e439/Volume%2014,%20Number%204,%20Winter%202010/Hajiani-14-4-4.pdf

Paradoxical Puborectalis Contraction and Increased Perineal Descent

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780204/


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## annie7

hi tummyrumbles

i read this pardoxical sphincter contraction article a couple years ago because after my defecogram, i started wondering the same thing..

you do have to click on the pdf file icon shown in the article to get the full story. it's quite interesting. there in the pdf file ( page 261) it does mention that a drawback of this study is that they only used one test--the defecography (radiology)-- in the study. and it goes on to say that three tests should be used to dx anismus (PSC or pfd)--the anorectal manometry, the defecography and digital rectal examination.

that's why a good, thorough gastro doc or colorectal surgeon will use all three tests.before a final diagnosis. that's what my gastro docs and colorectal surgeon did with me. they had me do all three tests. when they sent me to biofeedback, the readings on the sensor confirmed the tests' results. i had a second anorectal manometry as well, after my first biofeedback program.

i have a biofeedback machine that i use at home and it also shows a high resting tone initially, when i first start using it. fortunately i am able to bring down my numbers with my exercises and work with the machine.

the article does conclude that there is a trend toward a higher frequency of psc (or pfd) in patients with chronic constipation --also that there may be a subgoup of constipated patients who suffer from anismus as their main functional disorder.


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## tummyrumbles

Hello Annie

I'm glad you found something that helps. That's positive encouragement and it's good to know some things help.

About the testing: defecography is embarrassing and invasive. There are limitations because laboratory testing with a paste won't mirror moving your bowels in the privacy of your own home. I don't think there is a gold standard for PFD testing.

A person could test positive to all 3 tests but what does this tell them about where their stool is when they evacuate at home? Stool evacuation has a lot to do with diet. A meaningful test would involve taking a snapshot of the colon when the person is evacuating normally. It has always been hard for me to figure out where I am on the idiopathic constipation spectrum. I go every morning so don't have slow transit constipation; it's more of a timeliness problem. There's very few references to a sluggish colon in studies that I've found. It seems to be either a case of slow transit constipation where typically people are constipated for days or anismus where it's assumed the stool has transited OK but either the pelvic floor or sphincters are functionally blocking evacuation. My problem is more sluggish transit in the final leg but I haven't seen any references to this anywhere.

I know that the stool is still in transit when I'm in the bathroom because I used to feel clear after the first BM or two and get up to go to work. An hour or two later the next wave of stool would come down. It wouldn't be as urgent as it is for IBS-D because I'm guessing there's not that much there. I'm pretty sure this is what happens with most leaky gassers.

If the problem is more slow or sluggish colon transit then fibre is usually prescribed, but we know what fibre does for us - more constipation. This is a puzzle because how does fibre cause constipation? The only plausible explanation I can find is Dr Pimentel's theory on methane that says gasses in the digestive tract can act like neurotransmitters. This throws a question mark on the whole pelvic floor issue. What if the underlying cause isn't muscular at all but mediated by gasotransmitters?

Fear and stress pay a huge part in this. If your evacuation time is 3 hours for instance but you only allow 2 ½ in the morning then you're going to be very tense towards the end. This could account for the paradoxical obstruction. So much is tied in with the mind.

I think leaky gassers have this problem and maybe most other IBS people as well. If you genuinely just have pelvic floor dysfunction and the stool is ready to be evacuated in the rectum then yes, biofeedback or other relaxation techniques might help, as in your case. On the other hand if you have a sluggish as opposed to a slow transit then the only effective way that I know of to speed things up is reduce the digestion gasses through diet. Too much fibre can become inflammatory and can cause spasms which retard transit even further. This is assuming though that we all have IBS and an underlying problem with bacterial gas. Someone with slow transit constipation without PFD issues and who doesn't have IBS would probably benefit from more fibre.


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## annie7

oh yes--i agree with what you say about diet. also stress...

and yes pimentel's theory is very plausible. and yes in some cases the underlying cause, as you say, may not be muscular.

i have both slow transit constipation and pelvic floor dysfunction as well as a rectocele, rectal hyposensitivity and megarectum. it's probably a miracle i can go at all--lol.

based on my reading, research, what my gastros and colorectal surgeon told me, what i've read both on this and another board about other pfd sufferers' experiences, what their gastros and cr surgeons told them etc pelvic floor dysfunction is a very real problem for some of us. no question mark about it.

(and i'm not trying to argue here either nor do i want to provoke a long discussion--i don't have the time or a good enough internet connection for that--lol... just IMHO......based on my experience ...that's all i'm going to say here....take care...







)


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## tummyrumbles

No Annie I agree with you. For some of us it is PFD. For me maybe not so much. I'm glad you found something that works for you. You do a brilliant job considering everything that's stacked against you! Well done! And thanks for replying.


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## annie7

yes, biofeedback has helped me somewhat. i have made some progress but i still have a lot of work to do with it. years of tight muscle memory to unlearn. i may not be able to improve much more but fingers crossed working with my home machine will at least keep me from getting worse.

thank you for sharing all your hard work and research here on the board


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