Case control observational study conducted on DD patient and healthy control group.

1. evaluate psychiatric disorders among patients with dyssynergic defecation
2. evaluate the effect of delayed diagnosis of dysnergic defecation on the quality of the life

Functional constipation is a functional bowel disorder that presents as persistently difficult, infrequent, or seemingly incomplete defecation.

Subjective and objective definitions of constipation include:

(1) straining, hard stools (hard, inspissated stool), unproductive calls ("want to but cannot"), infrequent stools, or incomplete evacuation. (2) <3 bowel movements per week, daily stool weight <35 g/day, or straining >25% of the time Dyssynergia defecation is common and affects up to one half of patients with chronic constipation. This acquired behavioral problem is due to the inability to coordinate the abdominal and pelvic floor muscles to evacuate stool The etiology of dyssynergic defecation is unclear however it was found that the problem began during childhood in 31% of patients, and after a particular event, such as pregnancy, trauma, or back injury in 29% of patients, and there was no cause in 40% of patients.

The first step in making a diagnosis of dyssynergic defecation is to exclude an underlying metabolic or pathologic disorder .A detailed history, prospective stool diaries, and a careful digital rectal examination will not only identify the nature of bowel dysfunction, but also raise the index of suspicion for this evacuation disorder. Anorectal physiology tests and balloon expulsion test are essential for a diagnosis. Newer techniques such as high-resolution manometry and magnetic resonance defecography can provide mechanistic insights.

. anorectal dyssynergia impact quality of life and cause psychiatric problems such as of anxiety, depression, obsessive compulsiveness, psychoticism, and somatization.

So, the investigators aim to evaluate psychiatric disorders among those patients and impact of delayed diagnosis on their quality of life.

Inclusion Criteria:

• patients diagnosed as dyssynergia with anorectal manometric study

Exclusion Criteria:

• patient with diabetes mellitus ,hypertension ,chronic kidney disease ,and chronic liver disease patients
• patient with neurological disease
• patient with thyroid disease
• patient with past history of psychiatric disorders
• patients with past or current medications or substance induced psychiatric disorders

Disease group suffer from chronic conistipation and diagnosed dyssynergic defecation