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The functional anatomy of the pelvic floor consists of the pelvic diaphragm levator ani and coccygeus muscles and anal sphincters external and internal innervated by the sacral nerve roots S24 and the pudendal nerve Figure 1. The Clinical Practice Committee of the American Neurogastroenterology and Motility Society ANMS a professional organization of physicians and researchers has developed the ANMS Registry of Clinical GI Motility Laboratories that have experience in performing high quality GI motility procedures commonly used for the evaluation of patients.
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Anismus or dyssynergic defecation is the failure of normal relaxation of pelvic floor muscles during attempted defecationIt can occur in both children and adults and in both men and women although it is more common in women.
. It can be caused by physical defects or it can occur for other reasons or unknown reasons. This powerful group of hip extensors is used for functional activities involving upward and forward. Understanding the anatomy of the pelvic floor is essential to recognize its role in constipation.
The primary hip extensors are the gluteus maximus and the hamstrings ie the long head of the biceps femoris the semitendinosus and the semimembranosus. Dyssynergic defecation caused by poor coordination of the pelvic floor anal sphincter and abdominal wall muscles during attempted defecation results in prolonged or excessive straining even. The extensor head of the adductor magnus described later in this chapter is also considered a primary hip extensor.
Any congenital abnormality medical disease surgical procedure or drug that interferes with either central control of ejaculation or the peripheral control that includes sympathetic nerve supply to the vas deferens bladder neck prostate or seminal vesicles as well as the somatic efferent nerve supply to the pelvic floor can result in DEAE.
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