Abdomino-anal Dyscoordination in Defecatory Disorders

Sushmitha Grama Srinivasan, Anjani Muthyala, Mayank Sharma, Kelly Feuerhak, Andrea Boon, Kent R. Bailey, Adil E. Bharucha

Research output: Contribution to journalArticlepeer-review


Background & Aims: The contribution of the abdominal muscles to normal defecation and disturbances thereof in defecatory disorders (DDs) are unknown. Methods: In 30 healthy and 60 constipated women with normal rectal balloon expulsion time (BET) (n = 26) or prolonged BET (ie, DD; n = 34), seated anorectal pressures (manometry) and thickness (ultrasound) of the external and internal oblique and transversus abdominis muscles were measured simultaneously at rest, during hollowing, squeeze, evacuation, and a Valsalva maneuver. Results: Compared with healthy women with a normal BET, DD women had a lower rectal and greater anal pressure increase during evacuation (P ≤ .05), and more activation of the internal oblique and the transversus abdominis muscles during squeeze (P < .05). The change in transversus abdominis thickness during a Valsalva maneuver vs hollowing (rho = 0.5; P = .002) and separately vs evacuation (rho = 0.7; P < .0001) were correlated in DD but not in healthy women with a normal BET. A principal component (PC) analysis of anorectal pressures and muscle thicknesses during evacuation uncovered a PC (PC3) that was associated with a prolonged BET. Higher PC3 scores were associated with low rectal and high anal pressures at rest and during evacuation, thinner external oblique muscle, and thicker internal oblique muscle during evacuation. A greater PC3 score was associated with increased odds for DD vs health (odds ratio, 1.84; 95% CI, 1.05–3.23), and separately vs constipation with a normal BET (odds ratio, 3.64; 95% CI, 1.73–7.69). Conclusions: Taken together, these findings show 3, possibly inter-related, disturbances suggestive of dyscoordination in DD: aberrant activation of abdominal muscles during squeeze in DD, dyscoordination of the abdominal muscles during various tasks in constipated women, and abdomino-anal dyscoordination.

Original languageEnglish (US)
Pages (from-to)2091-2101.e5
JournalClinical Gastroenterology and Hepatology
Issue number9
StatePublished - Sep 2022


  • Biofeedback Therapy
  • Constipation
  • Dyssynergia
  • Manometry

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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