To Help Provide Sphincter Control for the Bladder and Bowel

What is the Pelvic Floor?

The pelvic floor is a set of muscles that spread across the bottom of the pelvic cavity like a hammock. The pelvic floor has three openings that run through it, the urethra, the vagina, and the rectum. The functions of the pelvic floor include:

 To support the pelvic organs, specifically the uterus, the bladder, and the rectum  To help provide sphincter control for the bladder and bowel  To withstand increases in pressure that occur in the abdomen such as coughing, sneezing, laughing, straining, and lifting  To enhance the sexual response

What is Anismus?

Anismus is when the external anal sphincter and puborectalis muscle involuntarily contract during attempted passing of feces (defecation), therefore obstructing your anus and causing constipation.

The anus is the opening at the end of your digestive tract that allows feces and waste to be expelled from the body. The external anal sphincter is a ring of muscle that closes off the anus to prevent unwanted leakage of fecal matter. The puborectalis muscle is a sling-like muscle that supports the rectum, and is part of the levator ani muscle group, which forms part of the pelvic floor. For normal passing of feces the puborectalis muscle and the internal and external anal sphincters relax to allow fecal matter to pass from your rectum through the anus to outside of the body. Cross-section of the anorectal canal

Symptoms of anismus include:

 Chronic constipation  Pain in the rectum and anus  Inability for the anus to open

If left untreated, anismus can cause fecal impaction and a stretching and enlargement of the rectum (megarectum). What Causes Anismus?

Anismus occurs when the puborectalis and external anal sphincter muscles are not properly coordinated and do not relax during the passing of feces. Spasm in these muscles can also cause anismus. Spasming may be caused by:

 Anal fissures  Hemorrhoids  Trauma to the external anal sphincter that may occur from surgery, childbirth or accidents.

How is Anismus treated?

In order to treat anismus, the following techniques may be used:

 Pelvic floor muscle reeducation using biofeedback. Biofeedback uses special computer equipment that measures muscle activity. You can use this feedback while you are doing exercises to learn to properly contract and relax the pelvic floor muscles.  Massage to the puborectalis and external anal sphincter muscles.  Stretching of the external anal sphincter muscle using dilators.  Botox injections to the puborectalis muscle or external anal sphincter.