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What causes obstructed defecation syndrome (ODS)?

Generally ODS is caused by the structural abnormalities associated with a weak pelvic floor or prolapse disease (intussusception or internal rectal prolapse, rectocoele [USA - rectocele]). Less commonly (about 5-10%), a tight pelvic floor is the cause.

What symptoms do patients get?

This syndrome is characterised by difficulty passing motions, multiple (often unsuccessful) visits to the toilet, a sensation of a blockage and incomplete emptying. Patients with ODS often use their finger to help them to empty, pushing on the perineum (the skin in front of the anal canal), on the back wall of the vagina or in the anal canal itself. As emptying may not be complete some patients describe leakage of a small amount of stool after they have been to the lavatory i.e. in addition to not being able to go properly, they also find that they have some symptoms of faecal incontinence.

How is ODS investigated and what tests are performed?

A careful assessment, examination and appropriate investigations by a Colorectal specialist will usually identify the cause and allow a management plan to be put in place. Your specialist may recommend a flexible sigmoidoscopy or colonoscopy to rule out rare causes for ODS. Anorectal physiology and endoanal ultrasound will help distinguish a weak from a tight pelvic floor. A proctogram looks at the co-ordination of the pelvic structures during defecation. A transit study will check to see if the colon is sluggish and failing to propel its contents to the rectum for defecation.

Which treatments might be offered?

Often patients can be helped with changes in diet or stool softeners. Pelvic floor retraining retrains the muscle of the pelvic floor and co-ordinates the muscles better. For those failing to improve with these measures and evidence of a structural cause for ODS such as an intussusception or rectocoele, surgery such as a rectopexy, STARR or rectocoele repair may be indicated.

Obstructed Defecation Syndrome (ODS)

Symptoms, causes, investigation and treatment

This is a common condition in which a person (typically female) cannot empty their bowel properly. As a result, they may go to the toilet repeatedly or try manoeuvres such as supporting the perineum to help the bowel motion come out through the anus. It is often due to weakness in the pelvic floor. A colorectal specialist assessment will usually be able to identify  the cause. Treatments differ according to the underlying problem.