Anismus is a medical condition where the external anal sphincter and puborectalis muscle malfunction, hindering defecation. It is more common in women and young children and can be caused by neurological conditions, rectal problems, and sexual abuse. Some medical professionals question its clinical significance, but it can cause constipation and fecal impaction if left untreated.
Anismus is a medical condition that involves the external anal sphincter and puborectalis muscle malfunctioning, whereby they experience a paradoxical or extreme contraction. Such a defect of these muscle fibers hinders defecation, which is the final stage of digestion, involving the expulsion of feces through the anus. Anismus is known by five other terms: anal sphincter dyssynergia, dyssynergic defecation, paradoxical puborectalis contraction, pelvic floor dyssynergia, and spastic pelvic floor syndrome. Anismus is more common in women and young children.
The external anal sphincter, also known as the sphincter ani externus, is an egg-shaped structure that usually measures about 3cm or 8cm. Placed about 4 inches (about 10 cm) from the anus, it helps protect the edges of the opening. A few inches above it is the puborectalis, or straight sphincter, which helps form a sling around the final part of the intestine before it ends at the part of the anus called the rectum. Its relaxation, together with other parts such as the external anal sphincter, reduces the angle between the rectum and the anus to allow for defecation.
Currently, medical researchers offer a number of reasons for the occurrence of anismus. The condition occurs in people who have Parkinson’s disease. This led to a 1988 report published in the Journal of Neurology, Neurosurgery and Psychiatry theorizing that anismus can be classified as focal dystonia. This means that it can be caused by a neurological condition characterized by an involuntary muscle contraction. Others suggest that anismus may be attributed to sexual abuse, specifically intercourse by inserting the penis into the anus rather than the vagina.
Also, anismus is more likely to appear in people with certain rectal problems. This includes rectal ulcers or sores; and rectal prolapse, which involves protrusion of the rectum through the anus. With women especially, the condition could present with rectocele, which is characterized by a tear in the thin structure that separates the rectum and vagina called the rectrovaginal septum.
Some medical professionals, however, have questioned the clinical significance of anismus. Many people with malfunctioning external anal sphincter do not develop the condition. Furthermore, a 1998 report, the result of a study conducted at the Rotterdam-Dijkzigt University Hospital in the Netherlands, discounted puborectalis muscle malfunction as a major cause of anismus. Without addressing the issue, however, with medical techniques like surgical resection, biofeedback training, or Botox injections, animus can cause constipation. This often leads to an enlargement of the rectum caused by fecal impaction, which involves trapping hardened stool in the organ. In some cases, patients may experience encopresis, which is involuntary fecal passing.
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