The Rome classification diagnostic criteria for functional defecation disorders is as follows: The diagnostic criteria for dyssynergic defecation is given as "inappropriate contraction of the pelvic floor or less than 20% relaxation of basal resting sphincter pressure with adequate propulsive forces during attempted defecation." The diagnostic criteria for inadequate defecatory Propulsion is given as "inadequate propulsive forces with or without inappropriate contraction or less than 20% relaxation of the anal sphincter during attempted defecation." The Rome criteria recommend that anorectal testing is not usually indicated in patients with symptoms until patients have failed conservative treatment (e.g., increased dietary fiber and liquids; elimination of medications with constipating side effects whenever possible).Various investigations have been recommended in the diagnosis of<unk> . Definition Several definitions have been offered: * "Absence of normal relaxation of pelvic floor muscles during defecation, resulting in rectal outlet obstruction". * "Malfunction (a focal dystonia) of the external anal sphincter and puborectalis muscle during defecation". * "... failure of the external anal sphincter and puborectalis muscles to relax, resulting in maintenance of the anorectal angle and the difficulty with initiating and completing bowel movements". * "... failure of relaxation (or paradoxic contraction) of the puborectalis muscle sling during defaecation, attempted defaecation or straining." Digital rectal examination Physical examination can rule out<unk>  (by identifying another cause) but is not sufficient to diagnose<unk> . Anorectal manometry The measurement of pressures within the rectum and anus with a manometer (pressure-sensing probe). Evacuation proctography defecating proctogram, and MRI defecography Classification<unk>  is classified as a functional defecation disorder. It is also a type of rectal outlet obstruction (a functional outlet obstruction). Where<unk>  causes constipation, it is an example of functional constipation. Some authors describe an "obstructed defecation syndrome", of which<unk>  is a cause. The Rome classification subdivides functional defecation disorders into 3 types, however the symptoms the patient experiences are identical. * Type I: paradoxical contraction of the pelvic floor muscles during attempted defecation * Type II: inadequate propulsive forces during attempted defecation (inadequate defecatory propulsion) * Type III: impaired relaxation with adequate propulsion It can be seen from the above classification that many of the terms that have been used interchangeably with<unk>  are inappropriately specific and neglect the concept of impaired propulsion. Similarly, some of the definitions that have been offered are also too restrictive. Rectal cooling test The rectal cooling test is suggested to differentiate between rectal inertia and impaired relaxation/paradoxical contraction Other techniques include manometry, balloon expulsion test, evacuation proctography (see defecating proctogram), and MRI defecography. Diagnostic criteria are: fulfillment of criteria for functional constipation, manometric and/or EMG and/or radiological evidence (2 out of 3), evidence of adequate expulsion force, and evidence of incomplete evacuation. Recent dynamic imaging studies have shown that in persons diagnosed with<unk>  the anorectal angle during attempted defecation is abnormal, and this is due to abnormal (paradoxical) movement of the puborectalis muscle.
Anismus
Trismus
Facial weakness
Hemifacial spasm
Strabismus
Ankyloglossia
Stridor
Dysphagia