Obstructed Defecation Syndrome in Young Women

Abstract

Obstructed Defecation Syndrome (ODS) is characterized by excessive straining at stool, incomplete rectal evacuation, and needing for perineal splinting. This condition is prevalent in young women suffering from constipation, approximating 7-15% [6]. ODS is refractory to laxative use. Typically, the block is found in the rectosigmoid portion. The main causes are divided into mechanical and functional. Mechanical causes interfere with stool passage, as can be found for instance in rectal prolapse. Functional causes include various neurologic or behavioral disorders, leading to pelvic floor dysfunction, discoordination of the defecatory process, and impaired rectal sensation. In dyssynergic defecation, that affects many young women with chronic constipation, there is an inability to coordinate the abdominal and pelvic floor muscles to evacuate stools. Paradoxical contraction of the pelvic floor muscles during defecation hinders evacuation [10-12]. ODS is characterized by persistent sensation of rectal fullness and painful prolonged or excessive straining, accompanied by a sensation of incomplete evacuation and clustering, often, digital manipulation. Hemorrhoids and fissures are also related to functional ODS due to the psychological condition to avoid pain during defecation. A holistic approach is needed for patients with ODS, considering that most of these young women present with psychological distress, either anxiety or depression. Anismus affects many ODS patients [8].