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:
- 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
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.