From the Guidelines
Obstructive defecation symptoms include difficulty initiating defecation, straining during defecation, incomplete evacuation, and the need for digital maneuvers to defecate, as well as symptoms such as incontinence of stool or liquid or gas. These symptoms can be caused by either structural or functional etiologies, including mechanical or structural issues like rectocele, enterocele, sigmoidocele, rectal intussusception, or rectal prolapse, or functional dyssynergia in anatomically normal patients 1. Patients with obstructive defecation may experience a range of symptoms, including:
- Difficulty defecating and requiring excessive straining or manual pressure for evacuation
- Incontinence of stool or liquid or gas
- Straining during defecation
- Incomplete evacuation
- Needing to use digital maneuvers to defecate
- Abdominal discomfort and bloating
- Prolonged time spent on the toilet
- Sensation of blockage in the rectum or feeling that the stool is "stuck"
- Chronic constipation with infrequent bowel movements
- Rectal pain or pressure during attempts to defecate
- Fecal incontinence due to overflow around impacted stool
Diagnosis of obstructive defecation typically involves a combination of clinical assessment, including digital rectal examination, anal manometry, and balloon expulsion test, as well as imaging studies to confirm or exclude underlying structural or functional abnormalities 1. The most effective approach to diagnosing and managing obstructive defecation involves a comprehensive evaluation of the patient's symptoms, medical history, and physical examination, followed by targeted diagnostic testing and treatment.
From the Research
Obstructive Defecation Symptoms
The symptoms of obstructive defecation include:
- Straining during bowel movements 2
- Hard and lumpy stools 2
- Incomplete evacuation 2
- Difficult evacuation 3, 4
- Need for digitation 3, 4
- Return to the toilet after defecation 4
- Perianal pain at defecation 3
- Laxative dependence 3, 4
- Constipation satisfaction 3
Common Complaints
Obstructive defecation symptoms are more frequent and bothersome than the frequency of bowel movements 2. These symptoms can significantly impact a patient's quality of life, making it essential to address them effectively.
Diagnostic Evaluation
Patient assessment is clinically based on the presence or absence of red flags 2. A thorough diagnostic evaluation is necessary to determine the best course of treatment for obstructive defecation.
Treatment Options
Various treatment options are available for obstructive defecation, including: