Obstructed defecation syndrome (severe constipation)

Obstructed defecation syndrome, severe constipation, rectocele (rectum bulges into vagina)

Obstipation is a common symptom that can be divided into slow transit and outlet obstruction, which is discussed here. The frequency of defecation comprises a large spectrum from 3 times a day to once every 3 days if a person feels good without any complaints. Further examinations are necessary if one or more criteria of the obstructed defecation syndrome (according to the ODS assessment score) are prevalent, e.g., bearing down, sensation of incomplete defecation or rectal blockage or manual support during defecation.

Diagnostics obstructed defecation syndrome

When investigating obstipation or obstructed defecation syndrome, a comprehensive evaluation of medical history (frequency and kind of defecation, use of laxatives, etc.) is crucial. The rectal examination (inspection, feeling for anomalies with fingers) and the rectoscopy/proctoscopy (inserting a rectoscope for better vision) are further diagnostic means. Rectoscopy/proctoscopy can also help find a rectocele, rectal tissue bulging into the vagina. If it has not been carried out yet, a colonoscopy (endoscopy of bowels) may also be necessary.

Anal manometry measures the pressure of the anal sphincter and provides information about the muscle tension and active function of the muscles. A bowel transit time test examines how long a meal takes to be digested. It is made visible by taking X-ray images after swallowing capsules with X-ray markers.

The best information can be derived from a depiction of the rectum and anal canal while it is working by using an MRI technique called MR defecography, which substituted the X-ray defecography. Therefore, a contrast agent is taken that will be visible on X-ray or MR images. The MR defecography is advantageous as doctors can evaluate the rectum and anal canal while defecating and contractions of the intestines, urinary bladder and uterus at the same time.

Treatment obstructed defecation syndrome

Primary treatment

The primary treatment of obstipation or obstructed defecation syndrome is conservative (non-surgical): diet counseling: sufficient intake of fluids (at least 2 liters/0.53 gallons), fibers (e.g., Mukofalk®), medication (glycerin or Lecicarbon® suppository). Not all laxatives are harmful: Makrogol® powder, Laxoberal® drops, if necessary at night, do not lead to an intestinal dependence on laxatives.

If the pelvic floor does not function properly, a so-called biofeedback treatment is promising. Via an electronic senor, patients receive feedback on the activity and strength of their pelvic floor. Pelvic floor exercises help attain a better control over these muscles by following the direct acoustic or visual feedback. As a result, the function of the pelvic floor significantly improves.

Surgical treatment

Given a diagnosed obstructed defecation syndrome caused by a rectal prolapse or an internal rectal intussusception (occult rectal prolapse), often together with a rectocele in women (rectum bulges into vagina), surgery is indicated. During STARR (= stapled transanal rectum resection), the prolapsed tissue will be removed.

Internal rectal insussusception (occult rectal prolapse) with rectocele (rectum bulges into vagina)