This is a short presentation on Obstructed Defecation Syndrome. This is a variant of a very severe form of constipation, compounded by several functional and organic disablities. Awareness amongst the physicians who primarily treat elderly patients and common people who suffer from chronic constipation is particularly important.

1. ODS – Obstructed Defecation Syndrome
DR DAIPAYAN GHOSH
MBBS, DNB, FMAS, FIAGES
www.scalpelmasters.in

2. ODS
Obstructive Defecation Syndrome
A Variant of Constipation
Slow Transit
Normal Transit
Defecatory Disorders

3. Rome II Criteria for Constipation (2000)
Two or more of the following for at least 12 weeks (not necessarily consecutive) in the preceding 12 months:
Straining during > 25% of bowel movements
Lumpy or hard stools for > 25% of bowel movements
Sensation of incomplete evacuation for > 25% of bowel movements
Sensation of anorectal blockage for > 25% of bowel movements
Manual maneuvers (digital evacuation, support of the pelvic floor) to facilitate > 25% of bowel movements
Less than 3 bowel movements per week
Loose stools are not present, and there are insufficient criteria for irritable bowel syndrome

4. Symptoms of ODS
Straining
Feeling Of Incomplete Evacuation
Repetitive Toilets Visit
Hard And Lumpy Stools
The Need For Digital Support To Expel Stool
Fecal Incontinence

5. The Iceberg Syndrome
Rectocele
Rectal Internal Mucosal
Prolapse (90%)
These are the Tip of
the Iceberg

6. The Occult Lesions..
Functional:
Anxiety – excessive straining
Depression
Anismus (Dyssynergic Defecation)
Non-relaxing pubo rectalis muscle on straining
Rectal Hyposensation
Pudendal Neuropathy- stretched pudendal nerves due to excessive straining
Spastic Colon

7. The Occult Lesions..
Organic:
Peritoneocele
Enterocele
Sigmoidocele
Colpocele
Cystocele
Recto-rectal Intussusception
Solitary Rectal Ulcer.

8. Evaluation:
 Rule Out Endocrine And Metabolic Abnormalities
 Colonoscopy
 CECT Abdomen Or Barium Enema

9. Dynamic Defecography (MRI)
is the routine radiological diagnostic tool
used to objectively assess
PELVIC FLOOR ANATOMY

10. Medical Management
Dietary Counselling (~25 To 30 G Of Fiber Daily)
Psychological Support, Pelvic Floor Rehabilitation
Biofeedback, Sacral Nerve Stimulation
Cathartics
Retrograde Rectal Irrigation Or Large Bowel Irrigation With Warm
Normal Saline
Colchicine/ Misoprostol/ Erythromycin/
Prucalopride (5HT4 Receptor Agonist)

11. Anismus
Yoga Exercises
50 Units Of Botulinum Toxin A: Trans Anal Injection
Into The Puborectalis Muscle
Biofeedback training of Pelvic Floor Mucles
Transanal Electrostimulation: Pudendal Neuropathy

12. Surgical Management
Transanal Surgery:
Partial division of Puborectalis
Internal Delorme’s procedure
PPH-STARR (Procedure for prolapse and haemorrhoids)
TST-STARR ( Tissue selecting therapy, Stapled transanal
rectal resection)
TRREMS (Trans anal repair of rectocele and rectal mucosectomy )
TERP (Trans-anal endoscopic microsurgery for internal rectal prolapse)
Bresler procedure with Linear stapler

13. Trans Abdominal Surgery
Complex Rectocele In Association With High-grade Intussusception
Laparoscopic Resection Rectopexy - Sigmoidocele
Laparoscopic Ventral Mesh Rectopexy – Rectal Prolapse
Subtotal Colectomy With Ileorectal Or Cecorectal Anastomosis
Segmental Colectomy
Restorative Proctocolectomy With Ileal Pouch-anal Anastomosis

14. Trans Vaginal Surgery
Posterior Colporraphy
With Plication Of The Levator Muscle
Anterior Levatorplasty
Transvaginal Schwandner Repair
Isolated Rectocele Without Significant Internal
Prolapse

15. To Summarize
The Iceberg Syndrome
The Occult Lesions: Psychosomatic Component Of ODS Should Be Recognized
And Managed
Surgery Alone For ODS May Be Good In The Short Term, But It Worsens Over
Time
Careful Patient’s Selection Is Crucial To Achieve Optimal Functional Results
Medical Management … 80%
PPH-STARR

16. Thank You !!