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What is Obstructive Defecation Syndrome?

Obstructive defecation syndrome is a condition characterized by difficulty passing stool through the rectum.

Causes of Obstructive Defecation Syndrome

Obstructive defecation syndrome is mostly associated with

  • Structural deformities in the rectum as a result of injury, ageing or genetic factors including:
    • Rectocele: Bulging of the wall between the rectum and vagina
    • Rectal intussusception: Collapse of the rectal wall causing infolding into the rectal cavity
    • Rectal Prolapse: Collapse of the rectal wall and infolding which projects outside the anus
  • Digestive tract problems
  • Stool impaction
  • History of more than 2 pregnancies
  • Injury during pregnancy
  • Weak hip muscles
  • Pelvic floor dysfunction
  • Neurological disorder
  • Rectal cancer

Symptoms of Obstructive Defecation Syndrome

Some of the common symptoms of obstructive defecation syndrome include:

  • Straining during defecation
  • Incomplete defecation
  • Feeling of blockage
  • Constipation or hard stools
  • Rectal pain
  • Frequent urination
  • Needing an enema or using digital pressure to empty the bowels

Diagnosis of Obstructive Defecation Syndrome

Your doctor will review your symptoms and perform a physical examination that includes examining the rectum with a gloved finger (digital examination). Diagnostic tests may be ordered that include:

  • Colonoscopy: A thin flexible light tube with a camera attached to its end is inserted through the anus to examine the rectum and colon and a biopsy (sample of tissue) is obtained for examination in the laboratory.
  • Sigmoidoscopy: Similar to a colonoscopy, in this procedure only the last portion of the colon (sigmoid) is examined.
  • Electromyography: This test detects the electrical activity of muscles and is used to determine if there is any weakness in the rectal muscles.
  • Anorectal Manometry: This test detects the contracting capacity of the rectum and anus.
  • Defecating proctogram: This is a specialized x-ray technique that produces clear images of the rectum during various stages of defecation.
  • Colonic marker: This test helps evaluate the efficiency of the digestive tract.

Treatment for Obstructive Defecation Syndrome

Treatment will be provided based on the causes and symptoms, this includes:

Conservative methods

  • Your doctor may prescribe medicines such as stool softeners to relieve constipation
  • Healthy diet: A nutritious high-fibre diet is recommended as well as drinking plenty of water.
  • Regular bowel habits are recommended
  • Pelvic floor physiotherapy: This is recommended for those with pelvic floor problems. You will learn how to control and relax the pelvic muscles to facilitate defecation. You will be instructed on:
    • Favourable sitting positions on the toilet
    • Avoiding straining during defecation
    • Exercises to relax the pelvic floor muscles
    • Other techniques to aid defecation

Surgical method

If conservative methods are found to be ineffective, surgery will be recommended and can include:

  • Rectocele repair: In this method, the bulging of the rectal wall into the vagina is repaired.
  • Stapled Transanal Resection of the Rectum: This is a minimally invasive procedure performed through the anus to treat a rectocele, intussusceptions or rectal prolapse. The prolapsed tissue is removed, and the anorectal wall is supported using a disposable stapler.
  • Laparoscopic ventral rectopexy: This is a keyhole surgery usually performed in women with rectal prolapse. An absorbable mesh is used to suspend the rectal and vaginal wall to the tailbone.
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