Understanding Dyssynergic Defecation: A Guide for Managing Bowel Health

Maya Illipse
Aug 18
4 min read

Updated: Sep 22

If you’ve ever sat on the toilet for far too long, wondering why your body just won’t cooperate, you’re not alone. Many people assume constipation is always about diet, dehydration, or stress. While those factors can play a role, there’s another cause that’s surprisingly common—especially in people with hypermobility, neurodivergence (such as ADHD or autism), or mast cell activation syndrome (MCAS). It’s called dyssynergic defecation.

The term may sound intimidating, but the concept is simple: the muscles that should be working together to help you go to the toilet aren’t coordinating properly. Instead of relaxing at the right time, your pelvic floor muscles tighten up, blocking the very movement you’re trying to make happen.

What Exactly is Dyssynergic Defecation?

When you sit down to have a bowel movement, your body is supposed to perform a smooth, automatic sequence:

Step one: the pelvic floor muscles relax, creating an open passage.
Step two: the abdominal muscles gently contract, pushing stool downward with steady pressure.

But in dyssynergic defecation, these steps get scrambled. The pelvic floor may contract when it’s supposed to relax, or the abdominal pressure may be too weak to help things along. It’s like trying to slide a box through a doorway while someone is quietly closing the door at the same time.

This miscoordination makes bowel movements slow, uncomfortable, and incomplete. People often describe a sensation of “still having something left” even after spending a long time on the toilet. Over time, the constant straining can lead to other problems, including hemorrhoids, small tears (fissures), or even changes to the pelvic organs.

Why Does This Happen in Hypermobility and Neurodivergence?

Although dyssynergic defecation can happen to anyone, it appears more frequently in individuals with conditions that affect body awareness and nervous system control:

Altered proprioception (body awareness): People with hypermobility often have trouble sensing where their joints and muscles are in space. If you can’t easily “feel” your pelvic floor, it’s harder to release it on command.
Nervous system regulation issues: Neurodivergence can come with differences in how the autonomic nervous system works. This can affect everything from gut motility to muscle tone.
Muscle guarding from pain: Chronic discomfort often leads to unconscious tightening of muscles—even inside the pelvis. The body gets stuck in a “protective brace” mode.
Gut–immune interactions: In conditions like MCAS, poor bowel emptying may increase gut inflammation or histamine release, which can in turn worsen motility problems.

This isn’t about “doing it wrong” — it’s about the way your body is wired and how different systems interact.

What Happens If It’s Left Untreated?

At first, dyssynergic defecation may seem like just an annoyance. But if it continues for months or years, it can cause a chain reaction of issues:

Straining injuries: hemorrhoids, anal fissures, or even pelvic organ prolapse.
Worsening constipation: stool can build up, becoming harder and drier, which makes the problem even more difficult to fix.
Digestive distress: bloating, abdominal pain, nausea, and appetite loss can follow.
System-wide effects: incomplete bowel emptying can aggravate symptoms of POTS, MCAS, or other dysautonomia by increasing gut inflammation or disrupting nutrient absorption.

This isn’t just a “bathroom problem.” Because the gut is so closely tied to the immune and nervous systems, poor bowel coordination can ripple outward into your overall health.

How is Dyssynergic Defecation Diagnosed?

If constipation isn’t improving with diet changes or over-the-counter remedies, doctors may look deeper. Diagnosis usually involves:

Symptom review: If you’ve been straining for months, have a sense of incomplete emptying, or need to use manual pressure (like pressing on your abdomen or perineum) to go, these are red flags.
Physical exam: A digital rectal exam can sometimes detect abnormal muscle patterns.
Functional tests:
Anorectal manometry: measures how your pelvic muscles contract and relax.
Balloon expulsion test: checks how easily you can pass a small balloon filled with water.
Defecography (MRI or X-ray): creates a moving picture of your pelvic floor as you attempt a bowel movement.

These tests are painless and give a clear picture of how well your pelvic floor is coordinating. If the problem is dyssynergic defecation, treatment can be very targeted and effective.

What Actually Helps? A Holistic Management Approach

The key to improvement isn’t “pushing harder.” It’s about teaching your body how to coordinate again. A good plan addresses both muscle training and nervous system regulation:

1. Get Into the Right Position

Use a small footstool (like a Squatty Potty) to raise your knees higher than your hips.
Lean forward slightly, with your elbows resting on your knees. This naturally straightens the rectal passage and makes things easier.

2. Use Your Breath to Relax

Practice deep belly breathing before and during bathroom visits to release tension.
As you bear down, exhale gently instead of holding your breath. Breath-holding (Valsalva maneuver) makes the pelvic floor clamp down even more.

3. Retrain Your Pelvic Floor

A pelvic health physiotherapist can use biofeedback to show you in real time when your muscles are tightening or releasing.
Visualization helps: imagine your pelvic floor dropping like an elevator or melting downward like butter.

4. Support Your Gut Health

Stay hydrated and increase fiber gradually—not in one big jump—to avoid bloating.
Try to use the bathroom at the same times each day, especially after meals when the colon naturally wants to move.

5. Treat the Whole Picture

Gentle movement practices like yoga, somatic exercises, or guided stretching improve proprioception and reduce muscle guarding.
Managing chronic pain, anxiety, or MCAS flares with your healthcare team will make pelvic floor retraining easier and more effective.

Why Raising Awareness Matters

Dyssynergic defecation isn’t rare, but it’s rarely discussed. People can go years thinking they simply have “IBS” or “stubborn constipation,” never realizing the root cause is muscular miscoordination.

The good news: this is treatable. With the right guidance, you can retrain your pelvic floor, restore smoother bowel function, and prevent long-term complications. Your gut—and your whole body—will thank you.

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