Treatment of Difficult/Obstructive Defecation

Massarat Zutshi, Lucia Camara Castro Oliveira
Treatment of Difficult/Obstructive Defecation is a topic covered in the ASCRS Textbook of Colon and Rectal Surgery.

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Key Concepts

  • Obstructed defecation syndrome is a subtype of constipation wherein patients usually complain of straining; incomplete, unsuccessful, or painful evacuation; bowel infrequency; abdominal pain and bloating; and the possible need for digitation.
  • Initial management is lifestyle advice, laxatives, and bowel retraining programs, including biofeedback and psychological support.
  • Diagnostic testing may point to a diagnosis, but clinical correlation should always be used.
  • Dyssynergic defecation is a clinical diagnosis and requires knowledge of anatomy and physiology for management.
  • Patients with overt rectal or anterior compartment prolapse and symptoms of obstructed defecation should be managed surgically.
  • Rectoceles, when symptomatic, require a surgical option.
  • Enteroceles and sigmoidoceles need a multimodal approach for effective symptom relief.

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Key Concepts

  • Obstructed defecation syndrome is a subtype of constipation wherein patients usually complain of straining; incomplete, unsuccessful, or painful evacuation; bowel infrequency; abdominal pain and bloating; and the possible need for digitation.
  • Initial management is lifestyle advice, laxatives, and bowel retraining programs, including biofeedback and psychological support.
  • Diagnostic testing may point to a diagnosis, but clinical correlation should always be used.
  • Dyssynergic defecation is a clinical diagnosis and requires knowledge of anatomy and physiology for management.
  • Patients with overt rectal or anterior compartment prolapse and symptoms of obstructed defecation should be managed surgically.
  • Rectoceles, when symptomatic, require a surgical option.
  • Enteroceles and sigmoidoceles need a multimodal approach for effective symptom relief.

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Last updated: January 26, 2022