Obstructed Defecation Syndrome Treatment

What is obstructed defecation?

Obstructed defecation syndrome (ODS) is a type of constipation in which stool reaches the rectum but cannot be passed easily. People with ODS often have the urge to go but need to strain for a long time, feel that the bowel has not emptied, or need to press around the anus or vagina to complete a bowel movement.

Common causes

• Rectocele: a bulge of the rectal wall into the vagina, common in women after childbirth
• Internal rectal prolapse (intussusception), where the rectal wall folds inwards
• Pelvic floor dyssynergia: the pelvic muscles tighten instead of relaxing during a bowel movement
• Weakness of the pelvic floor after childbirth, surgery or with ageing
• Long-standing straining habits

Symptoms

• Prolonged straining and spending a long time on the toilet
• A feeling of blockage or incomplete emptying
• Needing to press on the perineum or vagina to pass stool
• Repeated visits to the toilet
• Use of laxatives, enemas or suppositories without lasting relief

How it is assessed

Assessment includes a detailed history, examination and often specialised tests such as defecography (an X-ray or MRI study taken while you pass a contrast paste), anorectal manometry to measure muscle pressures, and sometimes a balloon expulsion test. Colonoscopy may be advised to exclude other bowel conditions.

Treatment options

1. Lifestyle and diet: fibre, adequate fluids, a regular toilet routine and correct sitting posture with the feet raised on a small stool.
2. Biofeedback therapy: guided pelvic floor retraining that teaches the muscles to relax at the right time. It is very effective for pelvic floor dyssynergia.
3. Medicines: stool softeners and laxatives used under supervision.
4. Surgery: for selected patients with a significant rectocele or internal prolapse that has not improved with conservative treatment. Options include STARR (stapled transanal rectal resection), rectocele repair and laparoscopic ventral mesh rectopexy.

Outlook

With the right diagnosis, many patients improve with non-surgical treatment. When surgery is needed, choosing the operation that matches the underlying problem gives the best chance of lasting relief.

Frequently asked questions

Is ODS the same as ordinary constipation?

Not exactly. In ordinary slow-transit constipation the stool moves slowly through the bowel. In ODS the main problem is getting stool out of the rectum.

Will laxatives cure ODS?

Laxatives can soften stool but do not correct the mechanical or muscle problem. Treatment depends on the cause found during assessment.

Do I need an operation?

Most patients start with diet changes and biofeedback. Surgery is considered only when tests show a structural cause and symptoms persist despite conservative care.

Related pages

• Rectal prolapse
• STARR procedure
• Faecal incontinence
• Dr. Ashok Kumar, Surgical Gastroenterologist

Book a consultation: call 0522-666-4444 or use the request call back form on this page. In an emergency, come straight to the 24/7 emergency department at Charak Hospital, Hardoi Road, Dubagga, Lucknow.