Criteria for dyssynergic defecation

A. Patients must satisfy the diagnostic criteria for functional chronic constipation (Rome III) and

B. Patients must demonstrate dyssynergia during repeated attempts to defecate

Dyssynergic or obstructive pattern of defecation (types 1-4) is defined as:

Paradoxical increase in anal sphincter pressure (anal contraction) or

Less than 20 percent relaxation of the resting anal sphincter pressure or

Inadequate propulsive forces observed with manometry, imaging, or EMG recordings and

One or more of the following criteria during repeated attempts to defecate:

Inability to expel an artificial stool (50 mL water-filled balloon) within 1 minute
A prolonged colonic transit time (ie, greater than five markers [>20 percent marker retention]) on a plain abdominal radiograph taken 120 hours after ingestion of one sitzmark capsule containing 24 radiopaque markers
Inability to evacuate or ≥50 percent retention of barium during defecography

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