What is obstructed defecation syndrome?

Obstructed defecation syndrome (ODS) is a condition characterised by difficulty in evacuating the bowels despite the urge to defecate. Patients with ODS often experience straining, a sensation of incomplete evacuation, and the need for manual assistance to pass stool. This syndrome can significantly impact quality of life, causing discomfort, embarrassment and frustration.

What causes obstructed defecation syndrome?

Several factors can contribute to ODS, including anatomical abnormalities and functional issues. Common causes include:

Rectocele: A bulging of the front wall of the rectum into the vagina, which can trap stool and impede its passage.

Intussusception: A condition where a part of the intestine folds into another section, creating a blockage.

Pelvic floor dysfunction: Weakness or lack of coordination in the pelvic floor muscles, which are crucial for controlling bowel movements.

Anal fissures or strictures: Narrowing or tearing of the anal canal, making defecation painful and difficult.

Rectal prolapse: When the rectum slips out of its normal position, either partially or completely, obstructing the passage of stool.

How do you treat obstructed defecation syndrome?

Treatment for ODS depends on the underlying cause and the severity of the symptoms. The primary aim is to relieve symptoms and improve bowel function. Treatment options can be broadly categorised into non-surgical and surgical approaches.

Can you treat obstructed defecation syndrome without having surgery?

Yes, non-surgical treatments are often the first line of management for ODS. These may include:

Dietary modifications: Increasing fibre intake and staying hydrated can help soften stool and promote regular bowel movements.

Medications: Laxatives, stool softeners or enemas may be prescribed to alleviate constipation and facilitate easier defecation.

Biofeedback therapy: This technique helps patients improve the coordination of their pelvic floor muscles through guided exercises and feedback from a healthcare professional.

Pelvic floor physiotherapy: Specialised exercises and techniques can strengthen the pelvic floor muscles and improve bowel function.

Manual evacuation techniques: In some cases, patients are taught safe methods to manually assist in stool evacuation.

What are the surgical options for obstructed defecation syndrome?

If non-surgical treatments are ineffective, or if the underlying cause of ODS is structural, surgical intervention may be necessary. Surgical options include:

Rectocele repair: Surgery to correct a rectocele involves reinforcing the rectal wall to prevent stool from getting trapped.

Resection rectopexy: This procedure is used to correct rectal prolapse by securing the rectum in its proper position.

Stapled trans-anal rectal resection (STARR): A minimally invasive surgery to remove excess tissue and reduce intussusception or prolapse.

Sphincteroplasty: Repairing the anal sphincter muscles if they are damaged or weakened.

Haemorrhoidectomy: If haemorrhoids are contributing to ODS, their removal may relieve symptoms.

What specialist treats obstructed defecation syndrome?

Obstructed defecation syndrome is typically managed by a colorectal surgeon. Colorectal surgeons specialise in the diagnosis and treatment of disorders affecting the colon, rectum and anus. They possess advanced training and expertise in both non-surgical and surgical treatments for ODS. Additionally, they often work in conjunction with gastroenterologists, pelvic floor specialists, and physiotherapists to provide comprehensive care tailored to each patient’s needs.

Patients with symptoms of ODS are usually referred to a colorectal surgeon by their GP or another healthcare provider. The specialist will conduct a thorough evaluation, which may include a physical examination, imaging studies and possibly endoscopic procedures, to determine the underlying cause of the syndrome and develop an appropriate treatment plan.

In summary, obstructed defecation syndrome is a multifactorial condition that can significantly affect a person’s quality of life. Understanding the causes, treatment options, and the role of specialists in managing this condition can help patients make informed decisions about their care. Through a combination of lifestyle changes, medical treatments, and, if necessary, surgical interventions, many patients with ODS can achieve significant symptom relief and improve their bowel function.