Obstructed defecation means difficulty pooping. This can be for a variety of reasons, both mechanical and psychological. People with obstructed defecation syndrome (ODS) feel that they can’t poop when they want to, they aren’t pooping often enough or they aren’t pooping everything out all the way. They suffer from constipation, but also sometimes from fecal incontinence, when backed-up poop overflows. They spend a lot of time on the toilet, waiting or straining to poop (defecate). Over time, excessive straining and passage of hard stools can deteriorate the muscles and nerves involved, which adds to the problem.
ODS is a broad umbrella term describing a range of conditions that involve constipation and difficulty defecating. What they have in common are the symptoms of constipation.
These symptoms may only be the tip of the iceberg, however. They often result from underlying conditions that have yet to be discovered.
Having chronic constipation for a long time can also cause its own set of problems. Sometimes, it’s hard to tell what the original cause was and what the effect was.
Women with obstructed defecation commonly have:
Pelvic floor dysfunction. The muscles and nerves in your pelvic floor can’t coordinate correctly to make a bowel movement.
Organ prolapse. One of the pelvic organs, such as the bladder, uterus or bowel, has fallen out of place and is bulging into another organ or falling out of the body.
Rectal hyposensation. A loss of the ability to sense stool in the rectum or the need to have a bowel movement.
Pooping anxiety. They might have a conscious or unconscious habit of guarding against hard, painful stools by stopping bowel movements.
About 18% of the population suffers from the broad range of conditions known as obstructed defecation syndrome. It’s especially common in women and after middle age.
Obstructed defecation feels like:
It may cause:
ODS has many causes, both organic and functional. Organic, mechanical causes include things like anatomical defects and physical blockages. Functional causes involve things like the brain and nervous system. Often both kinds are involved, and one kind may have caused another kind.
Perineal hernia. When organs in your abdomen or pelvis bulge through your pelvic floor.
Pelvic organ prolapse. When one of your pelvic organs has fallen out of place, intruding on your rectum or anus (rectal prolapse, rectal intussusception, rectocele).
Solitary rectal ulcer syndrome. One or several ulcers in your rectum.
Anismus (dyssynergic defecation). Inability to relax your sphincter muscles and/or push adequately to evacuate your bowels.
Rectal hyposensitivity. Loss of sensation in your rectum, possibly due to nerve damage.
Psychological disorders. Anxiety, depression, phobias, OCD (obsessive-compulsive disorder) and eating disorders.
Any of these may be either primary causes or secondary effects of obstructed defecation.
they may also have been caused by:
Pregnancy and childbirth.
Surgery in your pelvic region.
Traumatic injury or abuse.
The IWI team will begin by asking you about your symptoms and their severity. They may use a scoring chart to rate how severe your symptoms are including:
Your score would range from 0 to 20, with 20 points indicating severe symptoms. A high score indicates chronic constipation, but to diagnose ODS, your healthcare provider will need to rule out simple causes. They’ll do this through evaluation of your medical history and testing.
Once we understand your symptoms, we will recommend tests to learn more. These might include:
Digital Rectal Exam. This first line of testing is usually a physical exam using lubricated gloved fingers. Your healthcare provider can look for blockages, causes of pain and signs of organ prolapse, as well as test your muscle reflexes.
Defecography. X-ray or MRI imaging of your insides while you try to poop. Your healthcare technician will inject a medical substance into your anus for you to push out like you would a stool. You’ll do so in a private photographic chamber while they watch your organs on a computer screen outside.
Anorectal Manometry. This test measures how well your muscles and nerves work together to push poop out. A catheter with a balloon attached is inserted into your rectum and the balloon is inflated with warm water. The other end of the catheter is attached to a machine that will measure your muscle activity.
Because its causes tend to be complex, with many factors involved, treatment is often a combination of conservative treatments, holistic treatments and sometimes surgery.
For all people we recommend:
For neurological and psychosomatic symptoms, which affect up to two-thirds of people:
Robotic Rectopexy for rectal prolapse, restoring your rectum to its normal position, often with mesh to support it. Sometimes, this also involves the removal of part of your colon. Dr. Guerette is the most experienced surgeon in the region for this procedure.
Conservative treatments show improvement in 30% of people. Lifestyle changes and home remedies like laxatives and enemas may be needed indefinitely, but they can offer real relief. Therapies such as biofeedback and psychotherapy require time and commitment to yield results, but they can offer lasting improvements. Surgery can be very successful, especially when combined with physical therapy and other treatments.
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