Dysmotility

Dysmotility is a problem with your gastrointestinal motility — the muscle contractions in your GI tract that carry food through the digestive process. These muscles work automatically to keep food and fluids moving in the right direction at the right time. When they don’t work, it can cause a variety of problems with feeding, digestion and elimination (pooping). Dysmotility can affect any part of your GI tract.

Types of dysmotility

GI motility disorders can occur anywhere in your GI tract, including your:

• Esophagus
• Stomach
• Intestines
• Anus (butthole)

Esophageal dysmotility

Esophageal dysmotility can make it hard to swallow or keep food and fluids down. It can lead to food getting stuck on the way down, or food or fluids coming back up.

Some specific esophageal motility disorders include:

• Achalasia
• Cricopharyngeal spasm
• Esophageal spasm
• Esophageal stricture
• GERD
• Rumination syndrome

Stomach dysmotility

When the muscles in your stomach don’t function normally, your food may not break down as well as it should. Your stomach may hold onto your food for too long or release it too soon into your small intestine.

Some specific gastric motility disorders include:

• Cyclic vomiting syndrome
• Functional dyspepsia
• Dumping syndrome
• Gastroparesis

Intestinal dysmotility

Dysmotility can affect your small intestine or large intestine, or both. In your small intestine, it can cause bacterial overgrowth and poor digestion. In your large intestine, it can cause constipation or diarrhea.

Some specific intestinal motility disorders include:

• Paralytic ileus
• Small intestinal bacterial overgrowth (SIBO)
• Acute colonic pseudo-obstruction (Ogilvie syndrome)
• Chronic constipation
• Functional diarrhea
• Irritable bowel syndrome
• Functional bloating

Anal dysmotility

When your anal muscles don’t coordinate well, or they’re too tense, you may have muscle spasms or have difficulty pooping. If these muscles are too weak or lack control, you may poop unintentionally.

Some specific anal motility disorders include:

• Anismus (dyssynergic defecation)
• Hirschsprung’s disease
• Levator ani syndrome
• Fecal incontinence

Symptoms of dysmotility

Dysmotility in your GI tract may cause:

• Difficulty swallowing
• Backwash or regurgitation
• Indigestion or heartburn
• Fullness and bloating
• Nausea and vomiting
• Constipation
• Diarrhea
• Difficulty pooping
• Difficulty holding in poop

Dysmotility causes

The muscles in your GI tract move in response to signals from your nervous system. Dysmotility can happen if there’s a problem with the muscles themselves (myopathy) or a problem with the nerve signals that activate them (neuropathy). Injuries and surgeries can cause muscle damage or nerve damage, resulting in dysmotility. Diseases that affect your muscles or nervous system can, too.

Some causes include:

• Neurodegenerative diseases (like Alzheimer’s disease, Parkinson’s disease or multiple sclerosis)
• Nervous system injury (like a head injury, brainstem injury, spinal cord injury or nerve injury)
• Diabetes (diabetes-related neuropathy also increases your risk of neurodegenerative disease)
• Post-infectious syndromes (when bacterial or viral infections damage nerve or muscle function)
• Autoimmune diseases (like systemic sclerosis, lupus, esophagitis or inflammatory bowel disease)
• Surgery on your GI tract (like gastrectomy, bowel resection or Nissen fundoplication)
• Visceral hypersensitivity (excessively excited neurons in your GI tract)

Complications of dysmotility

GI motility disorders can cause difficulties with feeding or with digesting and absorbing nutrients from your food. This can lead to complications like malnutrition and electrolyte imbalances. Dysmotility in the lower part of your GI tract can cause various difficulties with pooping. Severe constipation can lead to complications like toxic megacolon. Dysmotility can also significantly affect your quality of life.

How doctors diagnose dysmotility

Diagnosing dysmotility is a process. Your provider will ask you about your symptoms and health history. Then, they’ll check to see if anything is physically blocking movement in your GI tract. Once they’ve ruled that out, they’ll try to observe how your GI tract moves. This might involve tests, like:

• Fluoroscopic GI X-ray exams
• Cine MRI
• Esophageal manometry test
• Gastric emptying study
• Wireless motility study
• Capsule endoscopy
• Anorectal manometry test
• Esophageal pH and impedance test
• Electrogastrography

You may need additional tests to help diagnose a specific motility disorder — like a blood test or biopsy.

How is dysmotility treated?

Most GI motility disorders aren’t curable, so treatment focuses on relieving your symptoms and addressing complications. This may involve medications, lifestyle changes and, sometimes, surgery.

Your provider may offer advice about foods to eat or avoid and dietary supplements to take. If you have serious malnutrition, they might suggest you get extra nutrition through a tube or through an IV.

They might suggest medications like:

• Proton pump inhibitors (for acid reflux)
• Prokinetics (to speed up intestinal transit)
• Antispasmodics (to relieve cramping)
• Neuropathic pain medications
• Laxatives (for constipation)
• Bulking agents (for diarrhea)
• Antibiotics (for bacterial overgrowth)
• Immunosuppressants (for autoimmune disorders)
• Antidiarrheals (for diarrhea)

If you don’t improve with medications, they might suggest procedures, like:

• Botox® injection
• Esophageal dilation
• Fundoplication
• Myotomy (muscle incision)
• Pyloroplasty
• Functional electrical stimulation
• Ostomy
• Antegrade enema
• Behavioral medicine
• Alternative medicine (like acupuncture)

What should I expect if I have GI dysmotility?

Dysmotility affects each person differently. Your symptoms may be minor or major. Sometimes, small changes make big improvements. In other cases, you might need to adjust your life around time-consuming treatments or have surgery before you find relief. One thing’s for sure: Your GI motility is crucial to your health. Your provider won’t stop until they find the treatment that works for you.