What is anorectal dysfunction?
Emptying your bowel should take a couple of relaxed minutes. It needs the rectum to sense fullness, the abdominal wall to generate gentle pressure, and the pelvic floor and anal sphincter to let go. In dyssynergia the last step misfires: the muscles paradoxically contract or simply do not relax, and the harder you push, the tighter they hold. Over time this produces incomplete emptying, haemorrhoids, fissures and a pelvic floor that is chronically overworked.
Anorectal pain conditions such as levator ani syndrome (a deep, dull ache or pressure in the rectum that is worse with sitting) come from the same overactive muscle group. Because these are patterns of muscle behaviour rather than structural damage, they can be retrained, and the trials on biofeedback are among the most convincing in pelvic health.
Common signs and symptoms
- Straining for long periods, even when stool is soft
- Feeling blocked or that emptying is incomplete
- Needing to press on the perineum or use a finger to help stool pass
- A dull ache, pressure or spasm deep in the rectum, often worse with sitting
- Haemorrhoids or fissures from repeated straining
- Alternating constipation with urgency or leakage
What causes it?
- Learned habits: rushing, hovering over public toilets, holding on, or years of straining
- Guarding after a painful fissure, haemorrhoid, surgery or childbirth injury
- A pelvic floor held tense from stress, pain or posture
- Altered rectal sensation, so the signal to go arrives late or not at all
- Pregnancy and childbirth, which stretch the pelvic floor and its nerves
- Overlap with irritable bowel syndrome and chronic pelvic pain
How pelvic floor physiotherapy helps
Physiotherapy for anorectal dysfunction teaches the muscles to do the opposite of what they have learned. Using external or, with your consent, internal feedback, your physiotherapist shows you what your pelvic floor is actually doing when you bear down, then trains relaxation, coordination and effective pushing until emptying becomes easy again.
A treatment plan typically includes:
- An assessment of pelvic floor coordination during a simulated bowel movement
- Biofeedback so you can see and feel the difference between bearing down and clenching
- Toileting mechanics: position (knees above hips, leaning forward), breath and a relaxed abdominal push
- Down-training and manual therapy for overactive, painful muscles, including levator ani pain
- Rectal sensation retraining where signals are dulled
- Stool consistency, timing and routine, coordinated with your physician or gastroenterologist
What the research says
The studies below are peer-reviewed and linked to their permanent records so you can read them yourself.
The Rome IV expert report defines the functional anorectal disorders (dyssynergic defecation, functional anorectal pain and functional faecal incontinence) and recommends biofeedback-based pelvic floor retraining as the treatment for dyssynergic defecation.
Rao SSC, Bharucha AE, Chiarioni G, et al.. Anorectal disorders. Gastroenterology, 2016. View study
In this randomized trial, biofeedback corrected the dyssynergic muscle pattern and improved bowel symptoms significantly more than sham feedback or standard care with diet, exercise and laxatives.
Rao SSC, Seaton K, Miller M, et al.. Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation. Clinical Gastroenterology and Hepatology, 2007. View study
For the bowel-leakage end of anorectal dysfunction, this Cochrane review found that sphincter exercises and biofeedback may improve symptoms, particularly alongside other conservative care.
Norton C, Cody JD. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database of Systematic Reviews, 2012. View study
Treatment at Corelife Wellness in Oakville
Corelife Wellness is a dedicated pelvic health clinic at 3075 Hospital Gate, Unit 312, Oakville, next to Oakville Trafalgar Memorial Hospital. Care starts with a free 15-minute consultation by phone, video or in person, followed by a full assessment with our Registered Physiotherapist. Every pelvis is unique, so your plan is built from that exam rather than a template. No referral is needed, and physiotherapy is often eligible under extended health benefits.
How assessment and treatment work, and how to book, are on our main page: Pelvic floor physiotherapy in Oakville.
Helpful reading from our team
When to see a doctor first
Pelvic floor physiotherapy is safe and you do not need a referral, but some symptoms need a medical assessment before or alongside treatment:
- Blood in or on the stool, or black stools
- A sudden change in bowel habit lasting more than a few weeks, especially after age 50
- Unexplained weight loss, anaemia or night-time symptoms
- Severe rectal pain with fever
- A family history of bowel cancer or inflammatory bowel disease
