Dyssynergia

Dyssynergia is any disturbance of muscular coordination, resulting in uncoordinated and abrupt movements. This is also an aspect of ataxia. It is typical for dyssynergic patients to split a movement into several smaller movements. Types of dyssynergia include Ramsay Hunt syndrome type 1, bladder sphincter dyssynergia, and anal sphincter dyssynergia. Dyssynergia is any disturbance of muscular coordination, resulting in uncoordinated and abrupt movements. This is also an aspect of ataxia. It is typical for dyssynergic patients to split a movement into several smaller movements. Types of dyssynergia include Ramsay Hunt syndrome type 1, bladder sphincter dyssynergia, and anal sphincter dyssynergia. Dyssynergia can be caused by disruption or damage between the cerebellum and the sacral spinal cord. Damage to the spinal cord can be caused by injury or acquired through hereditary means such as myelodysplasia. Other hereditary means of dyssynergia can be from multiple sclerosis and various manifestations of transverse myelitis. In addition, most brain damage to the cerebellum will cause dyssynergia. The cerebellum is split into three separate parts: the archicerebellum (controls equilibrium and helps to move the eye, head and neck), midline vermis (helps to move lower body), and lateral hemisphere (control of arms and quick movements). Damage to any part of the cerebellum can cause a disconnect between nerve cells and muscles, causing impaired muscle coordination. Ramsay Hunt syndrome type 1 is a rare, neurodegenerative disorder characterized by myoclonus, intention tremor, progressive ataxia and occasionally dementia. Bladder sphincter dyssynergia also known as detrusor sphincter dyssynergia is the decrease of detrusor (wall muscle of the bladder) pressure which causes unwanted urination. This is very common in spinal cord injuries and multiple sclerosis patients. There is a malfunction between the central nervous system, urinary sphincters, and detrusor muscles. Anal sphincter dyssynergia also known as pelvic floor dyssynergia is the weakening of the pelvic floor or sphincters in the anus. The pelvic floor are the muscles that attach to the pelvis in the abdomen. Anal sphincter dyssynergia can be caused by obstructions, but mostly improper relaxing of the anal sphincters or pelvic floor muscle during defecation. Also if there is a decrease in intrarectal pressure defecation can occur. Anal sphincter dyssynergia tends to be one of the most predicted diagnoses with a patient suffering from symptoms like chronic constipation and inability to control bowel movements. Diagnosis techniques for dyssynergia have been known to be expensive and aren’t commonly offered at some countrywide hospitals. Fortunately, there are still special tests and examinations that can be done given the proper medical care and treatment to properly detect and diagnose dyssynergia. Those following treatments include: anorectal manometry (balloon expulsion test and anal sphincter EMG), defecography studies, and digital rectal examinations (DRE). Anorectal manometry involves two separate tests: the balloon expulsion test and anal sphincter electromyography (EMG). These tests are performed in order to properly identify and diagnose dyssynergia. In order to prepare for these tests, a patient must fast and perform specific enemas recommended by their doctor two hours before their tests. When undergoing the balloon expulsion test, the patient has a small balloon inserted into their rectum, which is then inflated and filled with water. The patient is then instructed to go to the nearest bathroom and to attempt to defecate the balloon, where the time it takes is recorded by the doctors. An abnormal or prolonged time of expulsion of the balloon is seen as a problem in the anorectum region of the body and may lead to the diagnosis of dyssynergia, since the patient has a lack of control over their anorectal muscle contractions. Another technique used by doctors to test for dyssynergia is the anal sphincter EMG. This test involves the insertion of an electrode into the patient’s anal cavity, where they are asked to relax and push, as if they are trying to defecate. The electrical activity and contractile pressures of the patient’s anorectal contractions are recorded on a computer monitor and examined by the doctor. If the electrical activity of the contractions appear normal, but the patient still results in constipation, it would indicate that there is a problem in the muscle activity or that there might be a tear in the muscle. This can help lead to a diagnosis of dyssynergia or an alternative surgical cure. In defecography studies, doctors take an X-Ray of the patient and examine their rectum as it empties during defecation. Before the examination, patients are instructed to drink barium an hour before the examination. Barium paste is then inserted into the rectal and anal cavity, and for female patients X-Ray dye is placed on the urinary bladder and in the vagina. The barium is used so that the digestive tract, such as the intestines, rectal cavity, and anal cavity can be seen clearly on the X-Ray and the muscle movements can be examined by doctors.