BACKED UP AND CLENCHED UP: UNDERSTANDING PELVIC FLOOR DYSSYNERGIA, ANISMUS, AND TROUBLE POOPING
Feeling Backed Up? You’re Not Alone
If you feel bloated, gassy, or like you can’t fully empty your bowels no matter how much you try, you’re not alone. Many people strain on the toilet, spend too long wiping, or feel discomfort and pressure after going. These are common symptoms of pelvic floor dyssynergia, a condition where the muscles that help you poop are not working together as they should.
What Is Pelvic Floor Dyssynergia
The pelvic floor muscles are meant to relax during urination and bowel movements. In pelvic floor dyssynergia, they do the opposite. Instead of relaxing, they tighten when they should let go.
This lack of coordination can cause:
Straining during bowel movements
A sense of incomplete emptying
Cramping or bloating
Anal or pelvic discomfort
Spending longer on the toilet
When this coordination problem affects bowel movements specifically, it is called dyssynergic defecation.
Dyssynergic Defecation and Anismus
Dyssynergic defecation happens when the muscles involved in pooping fail to relax at the right time. Instead of working together, they resist each other, making it harder to pass stool. This can cause excessive straining and a constant feeling that stool is still there.
A related condition is anismus, a more specific pattern where the anal sphincter muscles involuntarily tighten or fail to relax during a bowel movement. Anismus can also occur during receptive anal play and often feels like blockage, pressure, or pain.
Both dyssynergia and anismus are learned muscle patterns. The body can develop these habits after pain, stress, or repeated difficulty going to the bathroom.
Why Does This Happen
Pelvic floor dyssynergia often develops from a learned response to pain, discomfort, or stress. Some common triggers include:
Chronic constipation
Painful bowel movements
Habitual straining or stool holding
Pelvic pain or trauma
Negative or stressful bathroom experiences
Fear or urgency around pooping
When the body associates the bathroom with pain or stress, the pelvic floor muscles start to brace as a form of protection. Over time, this becomes the default pattern. The more tension and urgency you feel, the more the muscles tighten, which makes the problem worse.
How It’s Diagnosed
Several medical tests can help identify pelvic floor dyssynergia and guide treatment.
Balloon Expulsion Test
A small catheter with a deflated balloon is placed into the rectum, filled with saline, and you are asked to expel it as if having a bowel movement. This measures how well the pelvic floor muscles relax and how long it takes to release.
Anorectal Manometry
This test measures the pressure and coordination of the anal sphincter and pelvic floor muscles. It helps identify whether the muscles contract or relax properly during simulated bowel movements.
MR Defecography
This specialized MRI shows how the rectum, anal canal, and pelvic floor move during an attempt to poop. It helps identify abnormal movement or structural issues that may contribute to difficulty emptying.
How It’s Treated
Pelvic floor physical therapy is the first-line treatment for dyssynergia. The focus is not on strengthening but on retraining the muscles to coordinate properly.
Assessment
A pelvic floor therapist begins with a comprehensive evaluation of the muscles, both externally and internally. During an internal exam, a gloved and lubricated finger is gently inserted into the rectum to assess tone, coordination, and strength. The therapist may ask you to contract, relax, or bear down to observe how the muscles respond. This helps identify whether they are tight or out of sync.
Pelvic Floor Retraining and Biofeedback
Treatment focuses on teaching the muscles to relax and coordinate with the rest of the body. One of the most effective tools is biofeedback.
Biofeedback uses sensors placed internally or externally to measure muscle activity. The results appear on a monitor, allowing you to see when your muscles are tightening or relaxing. This feedback helps retrain the brain and body to release instead of brace.
Biofeedback does not measure muscle strength. It shows timing and control, giving you a visual way to understand what your body is doing and how to change it.
Therapists may also use their finger, a mirror, or rectal trainers as additional forms of feedback.
What Are Rectal Trainers
Rectal trainers are silicone, hourglass-shaped tools that come in different sizes. They are used to gently stretch and desensitize the anal opening while helping you practice relaxation.
Under the guidance of a therapist, rectal trainers can be used at home to improve coordination. The process involves inserting the trainer with lubrication and focusing on breathing and softening the muscles instead of pushing or tightening.
Calming the Gut and Nervous System
Retraining the pelvic floor is only part of the process. Calming the nervous system and supporting digestion are equally important.
A pelvic floor therapist may include:
Abdominal massage to improve gut motility and reduce bloating
Stretches for the hips, back, and pelvic area to reduce muscle tension
Toilet posture adjustments using a footstool or Squatty Potty to improve bowel mechanics
Breathing techniques that connect the diaphragm and pelvic floor, teaching the muscles to expand on inhale and release on exhale
These strategies help the body feel safe to relax and release stool naturally.
Nutrition and Hydration
Healthy bowel movements depend on stool consistency. If stool is too hard or dry, even well-coordinated muscles will have trouble.
Support your digestive system by:
Drinking enough fluids to keep urine light yellow
Eating balanced meals with fruits, vegetables, whole grains, and healthy fats
Getting adequate fiber for stool bulk and softness
If you have ongoing digestive issues, working with a registered dietitian can help tailor a plan for your body’s needs.
The Takeaway
Pelvic floor dyssynergia and anismus are common but often overlooked causes of chronic constipation and straining. They are not mental or emotional problems but muscle coordination issues that can be retrained with proper therapy.
If you often feel like your body is fighting you when you try to poop, there is help available. Pelvic floor physical therapy, biofeedback, and simple home strategies can make a major difference in comfort and bowel function.
Watch the Full Video
To learn more about how pelvic floor dyssynergia and anismus affect your ability to poop and how to retrain your body, watch my full video:
For deeper learning, live Q&A sessions, and step-by-step tutorials on pelvic and sexual health, join me on Patreon:
This information is not intended to substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a healthcare professional with any questions you may have regarding treatment, medications/supplements, or any medical diagnoses. This information is intended for educational purposes only and is in no way to substitute the advice of a licensed healthcare professional.
