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Constipation due to pelvic floor dysfunction / obstructed defecation / dyssynergistic defecation


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Hi everyone,
I'm wondering if anyone has experience with dyssynergistic defecation/ obstructed defecation / pelvic floor dysfunction (It's basically a condition where your pelvic floor muscles don't relax as they should and your stool tends to become stuck in your rectum). I have a question about recovering from this condition:
First my story:
I was diagnosed with this condition by anorectal manometry last November, as described in this article (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4930297). Since then I've received biofeedback therapy / training to use my pelvic floor muscles properly (https://sci-hub.do/10.1023/a%3A1018846113210). Mercy Baltimore (https://mdmercy.com/centers-of-excellence/digestive-health-and-liver-disease) has an advanced setup with high-resolution intrarectal and anal pressure monitoring. They charge something like $500 per 1-hour session, and my insurance doesn't cover it. Johns Hopkins physical therapy and InBalance Physical Therapy (https://www.inbalancephysicaltherapy.com/) have a less advanced setup with voltage monitoring of the anal sphincter and with my insurance they come to $70 per 1-hour session. I was also able to rent a basic voltage biofeedback unit (https://www.cmtmedical.com/product/pathway-tr-20/) for $100/month. For cost reasons, I've mainly worked with Hopkins and InBalance, and I've improved my performance voltage-wise (I can keep my anal voltage < 1.7 uV pretty much all the time and do maneuvers like quick squeezes and long holds and relax immediately thereafter). I've also improved my symptoms. I used to have several nights a week where I had to use saline enemas to reduce my abdominal pain so that I could sleep. In the last 2 months, I've had 2 nights where that happened, and several nights where I spent 1 or 2 hours past my bedtime have a bowel movement so that I could sleep.
I also follow a low FODMAP diet, log my diet in MyFitnessPal, and work with a nutritionist. I eat about 40 g of fiber a day, mostly from low FODMAP vegetables, so I know my constipation isn't from low fiber.
I've also had hydrogen breath testing to rule out SIBO.

So overall I'm doing much better. But I'm not fully recovered yet. I think it could be I'm not doing a good job of using my abdominal muscles like the transversus abdominis to increase intrarectal pressure (as described inhttps://sci-hub.do/10.1023/a%3A1018846113210)), and my physical therapists think that's plausible. So they've taught me a lot of core exercises like the dead bug (https://www.healthline.com/health/exercise-fitness/dead-bug-exercise) which strengthen transverses abdomens. Besides doing exercises like these, do any of you have other things which you've found found helpful in your experience?



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