Anismus - Diagnosis

Diagnosis

The Rome classification diagnostic criteria for functional defecation disorders is as follows:

1. Patient must satisfy diagnostic criteria for functional constipation
2. During repeated attempts to defecate must have at least 2 of the following:

• Evidence of impaired evacuation, based on balloon expulsion test or imaging

• Inappropriate contraction of the pelvic floor muscles (ie, anal sphincter or puborectalis) or less than 20% relaxation of basal resting sphincter pressure by manometry, imaging, or electromyography

• Inadequate propulsive forces assessed by manometry or imaging

The diagnostic criteria for dyssynergic defecation is given as "inappropriate contraction of the pelvic floor or less than 20% relaxation of basal resting sphincter pressure with adequate propulsive forces during attempted defecation."

The diagnostic criteria for inadequate defecatory Propulsion is given as "inadequate propulsive forces with or without inappropriate contraction or less than 20% relaxation of the anal sphincter during attempted defecation."

The Rome criteria recommend that anorectal testing is not usually indicated in patients with symptoms of until patients have failed conservative treatment (e.g., increased dietary fiber and liquids; elimination of medications with constipating side effects whenever possible).

Various investigations have been recommended in the diagnosis of anisumus.