Update on obstructed defecation syndrome

Abstract

The most common cause leading to primary constipation is obstructed defecation syndrome (ODS). Anatomical disorders in the pelvic floor region (rectocele, enterocoele, rectal intussusception, and rectal prolapse) result in ODS. However, it always occurs in combination with a functional defect of defecation. This review offers an in-depth look at ODS diagnosis and treatment. Conservative or surgical treatment options are available. Conservative treatment includes several approaches to defecation practice and regimen and dietary measures combined with pelvic floor rehabilitation and psychological support. However, some patients require surgical intervention as ODS symptoms might persist despite conservative treatment. Surgical approaches include transvaginal, transabdominal, and transanal procedures. The most widely used are the transanal procedures, which are associated with good short-term results and low complication rates. Nevertheless, the long-term complications are still unknown and being discussed. The underlying cause of ODS is a combination of functional and anatomical abnormalities; therefore, treatment should be focused on pelvic organ systems for several reasons. Accordingly, only a multidisciplinary approach and (multimodal) combination of different approaches can be used to avoid inferior results in this challenging area.