Obstructed Defecation Syndrome

Obstructed defecation is when you have a hard time pooping (defecating). This can happen for many reasons, stemming from your physical and even mental health.

If you have obstructed defecation syndrome (ODS), you may be dealing with pooping problems often. Over time, lots of straining to poop and passing hard poops (stools) can damage the muscles and nerves involved in the process. This makes the condition worse.

Symptoms of obstructed defecation syndrome

If you have ODS, you may feel like you:

• Can’t poop when you want to
• Aren’t pooping often enough
• Aren’t getting all the poop out
• Are constipated even though you’re leaking poop

You may also spend a lot of time on the toilet waiting or straining to poop. Or you might feel the need to use your fingers to get everything out in one go. You may also rely heavily on laxatives or enemas to speed the process along.

Other noticeable symptoms, on or off the toilet, include:

• Inflamed or swollen rectum
• Painful and swollen belly
• Pain in your anus (butthole)
• Nausea and loss of appetite
• Fatigue

As ODS gets in the way of plans or affects your ability to spend time with others, you might experience anxiety and depression.

Obstructed defecation syndrome causes and risk factors

Many conditions can cause ODS. Organic, mechanical causes include differences in your body that make it more likely for something to block the poop from coming out. Functional causes include problems with the way your muscles move when you try to poop. This is because your brain and nervous system aren’t on the same page.

Mechanical causes of ODS include:

• Prolapse: One of the organs in your pelvis has fallen out of place and sags into your rectum or anus.
• Rectal intussusception: Your rectum collapses on itself internally, which can make you feel like you have to poop. This can also lead to rectal ulcers.
• Perineal hernia: Organs in your belly or pelvis bulge through your pelvic floor.

Functional causes include:

• Anismus (dyssynergic defecation): You can’t relax your pelvic floor muscles or push enough to get all the poop out.
• Rectal hyposensitivity: You’ve lost sensation in your rectum, possibly from nerve damage.
• Mental health: Anxiety, depression, phobias, OCD and eating disorders can affect how you relate to and use your pelvic muscles.

There are also situational causes of ODS, which include:

• Pregnancy and childbirth
• Surgery in your pelvic region
• Traumatic injury or abuse

Your experience with ODS may only be the tip of the iceberg. It may point to underlying conditions that haven’t been properly diagnosed. And having chronic constipation can cause its own set of problems. This can make it hard to tell the difference between the cause and the effect.

Most people with ODS have a female reproductive system. So, being female may increase your risk of having ODS.

Can endometriosis cause obstructed defecation syndrome?

Yes. If endometriosis also affects the tissues near your GI tract, it can lead to bowel problems that include obstructed defecation. But this is rare.

Complications of obstructed defecation syndrome

Without treatment, ODS may cause:

• Fecal impaction
• Rectocele
• Intussusception
• Rectal prolapse

In the past, experts thought these conditions contributed to ODS. But newer research suggests that they may happen because of it.

How doctors diagnose obstructed defecation syndrome

First, your healthcare provider will ask you about your symptoms. They might use a scoring chart for constipation, like this one, to see how severe your symptoms are.

Your total score ranges from 0 to 20 points, with 20 suggesting that you have severe chronic constipation. But your provider still has to rule out other causes to diagnose you with ODS. To do this, they’ll take a look at your medical history and run some tests.

Tests

Tests that help diagnose ODS include:

• Anorectal manometry with balloon expulsion test: A provider inserts a catheter with an inflated balloon into your rectum to measure muscle activity. You may also be asked to try “pooping” the balloon out.
• Colonoscopy: A provider places a tube with a light and camera on the end up your anus and into your colon. They inspect your colon for signs of disease or damage.
• Defecography: An X-ray with contrast dye or an MRI allows providers to watch your muscles and organs work together to poop.
• Digital rectal exam: This is a physical exam of your anus and rectum. A provider uses a gloved, lubricated finger to look for blockages, causes of pain and signs of prolapse. They also test your muscle reflexes.

How is obstructed defecation syndrome treated?

Because the causes of ODS tend to involve many factors, providers like to take a conservative and holistic approach to treatment. Even when a provider recommends surgery — and even when it’s successful in correcting the structure of a body part — it doesn’t always lead to lasting relief. Symptoms can continue or even come back. That’s because there can still be other factors that haven’t been diagnosed.

If you have ODS, your provider’s recommendations might include:

• Eating foods rich in fiber or taking fiber supplements
• Staying hydrated throughout the day
• Using stool softeners, laxatives or home enemas
• Practicing yoga and guided relaxation

If your symptoms have to do with the way your brain and body communicate while you poop, your provider might suggest:

• Biofeedback therapy
• Pelvic floor rehabilitation
• Psychotherapy

If your ODS involves problems with a specific body part and other treatments aren’t working for you, your provider may recommend surgery. This can include:

• Posterior colporrhaphy: This surgery pushes your fallen rectum back into place when you have a rectocele.
• Rectopexy: If you have rectal prolapse, a provider puts your rectum back in place and inserts mesh to support it. Sometimes, they may also take part of the colon out.

When should I seek care?

Seek medical help if:

• Your symptoms come back or get worse, even with treatment
• You feel pressure or fullness inside your rectum or vagina
• You’re leaking mucus, poop or blood out of your anus

What can I expect if I have obstructed defecation syndrome?

Therapies for ODS, like biofeedback, take time and commitment. But they might offer lasting improvements in your quality of life. Adopting daily habits will also help you manage the condition, as will surgery if it’s part of your overall care plan.

ODS is a lifelong condition. It may take some time to find the right treatments. But once you do, they can offer real relief.