Obstructive defecation syndrome is an emptying disorder in the rectum and manifests itself particularly in women. Symptomatically, the disease manifests itself in a persistent urge to defecate with mostly incomplete evacuation and the need for strong pressing. Conservative and surgical treatment steps are possible.
What is obstructive defecation syndrome?
Various diseases and symptoms that affect defecation are summarized as emptying disorders of the rectum. Obstructive defecation disorder is one of these diseases. The most common symptom of the phenomenon is chronic constipation. The patients usually feel a persistent urge to defecate and, even after a bowel movement, have the feeling that they have only achieved incomplete defecation. See aviationopedia for Mediastinitis Explanations.
Obstructive defecation syndrome is a relatively common phenomenon. Women are more likely to be affected by the syndrome than men. Especially women who have had several births or who have had their uterus removed recently are at increased risk of obstructive defecation disorders. The most common age for the disease is around the sixth decade of life.
Changes in sections of the intestine are observed in connection with the syndrome in almost all cases. These changes may be age-related or due to primary conditions such as chronic constipation.
Due to the frequent association of the obstructive defecation disorder with previous births or a hysterectomy, a connection between the phenomena is obvious. This would also explain the gender preference of the disease. According to current medical opinion, the emptying disorder of the rectum can be traced back to two different intestinal changes.
On the one hand, a ventral rectocele can be present. This is an internal bulge in the rectum that points forward. On the other hand, the cause of the symptoms can be an internal rectal prolapse. With this phenomenon, a part of the rectum invaginates itself. The phenomenon is also known as rectoanal internal intussusception. The ventral rectocele is the most common change observed in association with defecation disorder.
This rectocele is usually associated with other functional disorders in the area of the pelvic floor, such as can occur after childbirth or uterine surgery. The definitive cause of obstructive defecation disorder depends on the individual case, but pelvic floor disorders are considered to be the most common primary cause.
Symptoms, Ailments & Signs
Obstructive defecation syndrome can manifest itself clinically in a wide variety of ways. Typically, those affected state in the anamnesis that they suffer from futile, long-lasting visits to the toilet every day, during which they either have to push hard to defecate or have no success at all. You have a constant feeling of incomplete evacuation.
In addition, they often suffer from discomfort or even pain due to the increased pressure on the pelvic floor area. Persistent constipation may cause abdominal pain or nausea. In the course of the defecation disorder, faecal incontinence can develop in the sense of a weakness in holding stool, which initially corresponds to stool smearing and from there often progresses progressively.
A history of using certain laxatives or enemas is often reported. Defecation with the help of the fingers can also be characteristic. In addition to a general feeling of pressure, bleeding occurs in individual cases, which is usually due to the intensive pressing. Clenching can also lead to enlarged hemorrhoids in the long term.
Diagnosis & course of disease
When taking the medical history, the doctor develops a first suspicion of obstructive defecation syndrome. The subsequent basic diagnostics include a physical examination with a colonoscopy and an ultrasound of the sphincter. Pressure is often also measured on the sphincter muscle.
As an additional diagnostic procedure, a defecography can be considered as an X-ray examination with the administration of contrast medium, which clarifies the changes in the intestine. In the differential diagnosis, the doctor must rule out diseases such as chronic constipation, colon transport disorders, segmental transport disorders and functional disorders.
The classification of the intestinal changes is one of the most crucial moments of the diagnosis, since a promising therapy can only be developed by identifying the actual causal problem. The prognosis for patients with obstructive defecation disorder is considered favorable.
An obstructive defecation disorder should always be treated, since its symptoms continue to worsen due to the existing connective tissue weakness. In most cases, this does not lead to life-threatening complications. But the quality of life suffers greatly. Complications can arise, especially when trying to make defecation a success by pressing hard.
Hard pressing usually doesn’t help, but increases the visible rectal prolapse and can cause bleeding due to the further development of the hemorrhoids. Subsequently, the development of fecal incontinence is possible. A cystocele can also occur in some women. A cystocele represents the prolapse of the bladder into the anterior septum. This leads to permanent urinary tract diseases, urinary retention or even urinary incontinence.
Without treatment, there is a constant progression of the symptoms with a severe reduction in quality of life. This can also result in mental illness. Chronic pain, the feeling of incomplete emptying as well as faecal and urinary incontinence can lead to sleep disorders, psychosomatic illnesses or even depression.
In rare cases, untreated obstructive defecation disorder also leads to an enterocele. This is a prolapse of sections of the small intestine into the pocket-shaped depression of the peritoneum between the uterus and rectum (Douglas space). With an enterocele there is always a risk of developing an intestinal obstruction.
When should you go to the doctor?
In obstructive defecation disorder, defecation is disrupted by incomplete emptying of the bowel. Because of the level of suffering that can be associated with this problem, it is imperative that you see a doctor. Anyone who feels the constant urge to defecate is severely restricted in their quality of life.
A normal constipation usually resolves after the bowel has been emptied. If constipation problems persist, it is often sufficient to change your diet. More fiber, more fluid intake and more exercise solve this problem. No doctor’s visit is necessary for this. However, with obstructive defecation disorder, there can be accompanying symptoms and pain. There is also a risk of developing fecal incontinence, cystocele or haemorrhoids in the medium term. A rectal prolapse due to strong straining is also possible.
The doctor should therefore be consulted if there is a suspicion of an obstructive defecation disorder. The treatment options available include conservative or surgical methods. The proximity of the obstructive defecation disorder to other voiding disorders complicates the diagnosis. For this reason alone, a doctor should be consulted if there are persistent problems with emptying the intestines. It must be clarified whether it is a disease that requires treatment, a remediable disorder or a psychological problem with voiding.
Treatment & Therapy
Patients with obstructive defecation syndrome can be treated conservatively or surgically. If there are no changes in the intestine, conservative symptomatic therapy is carried out. This treatment includes, above all, a change in diet, which is usually combined with the administration of stool-softening medication.
If, on the other hand, there are changes in the intestine, surgical causal therapy is usually carried out. In the context of this therapy, the complaints are ideally not treated symptomatically, but eliminated causally. This means that the defecation disorder is considered a curable disease. For example, the procedure of transanal resection of the lower rectum, also known as a STARR operation, can be used for surgical treatment.
This procedure is based on two circular staplers and corresponds to a more recent treatment option for defecation syndrome. The treatment option was developed for causes such as internal rectal prolapse or ventral rectocele and is intended to restore the healthy anatomy of the rectum.
The rectal muscle wall regains its continuity through the operation, so that any problems with holding the stool can also be corrected by the operation. The rectum returns to average normal capacity. Anatomically, the rectocele or rectal prolapse is permanently corrected with the procedure.
Outlook & Forecast
Obstructive defecation disorder has a good prognosis. The earlier a diagnosis is made and treatment can be started, the better the further health development. The administration of medication alleviates the existing symptoms. The symptoms gradually regress until finally a recovery achieves it.
In the case of a difficult course of the disease, an operative intervention must be carried out. This is associated with risks and side effects. Nevertheless, in most cases it proceeds without further complications. After the wound has healed, complete freedom from symptoms is usually documented in the patient within a few weeks or months.
Without medical treatment, the disease can progress. The symptoms gradually increase in intensity and scope. This significantly affects the quality of life. Spontaneous healing does not occur in most cases. Rather, secondary diseases and functional disorders are possible. In the case of a particularly unfavorable course, an intestinal obstruction occurs. This poses a potential threat to human life.
Due to this possible development, cooperation with a doctor should be sought as soon as the first irregularities occur. Although the treatment is usually uncomfortable, it still results in regression and full recovery. The use of further control examinations is also decisive for the further positive course.
A promising preventive measure for obstructive defecation disorders is above all a suitable diet that gives the stool a normally soft consistency and thus counteracts chronic constipation. Pelvic floor training can also reduce the risk of defecation disorders. Apart from that, there are hardly any preventive measures against age-related changes.
Once the cause of obstructive defecation has been treated, follow-up care is usually of crucial importance. The reason is that the defecation disorder is often behavior-related, namely through heavy straining during a bowel movement. In order to avoid this, it is essential to pay attention to stool regulation during aftercare.
Constipation encourages straining, so stool should be soft and ideally bulky. Those affected achieve this through a high proportion of fiber in their diet. Fruit and vegetables are just as recommended in this context as whole grain products.
It is also better for those affected to avoid sugar in large quantities. The same applies to a high proportion of meat in the diet and the consumption of alcohol. Yoghurt products, on the other hand, can often have a beneficial effect. It is also important to drink enough, which is best covered with water and unsweetened herbal teas.
Exercise is also an important factor in the follow-up of obstructive defecation disorder that cannot be neglected. The walk or physical activity, ideally in the area of endurance, stimulate the natural movement of the intestines and thus promote emptying. Massages in the abdominal area can also activate these bowel movements. Anyone who still tends to have defecation disorders can often overcome this in a squatting position on the toilet, in which the feet are placed slightly higher and the upper body is tilted slightly forward.
You can do that yourself
The most important self-help measure for obstructive defecation disorders is a medium- and long-term change in diet. The main thing to do here is to use foods that promote regular and soft bowel movements. Dietary fibers play a crucial role here. Whole grain products, legumes, seeds and grains are considered ideal. Chewing well increases the effect. You should also drink plenty of fluids.
However, since digestion works differently for everyone, you can experiment a little here. For some people, dairy products or fruit, for example, also lead to softer and more regular bowel movements. In addition, exercise can alleviate suffering from obstructive defecation disorder. Particularly light endurance sports such as swimming, jogging or walking can stimulate peristalsis and relieve constipation.
It may be useful to defecate in a squatting position. For this purpose, the feet are placed on a stool about 20 to 30 centimeters high in front of the toilet. The upper body is bent slightly forward so that there is an angle of about 35 degrees between the thighs and the upper body. This position is evolutionarily designed for defecating and is maintained by most mammals. Accordingly, humans can also make their bowel movements easier and reduce the risk of the bowel not being completely emptied.