Obstructed defecation syndrome (abbreviated as ODS, with many synonymous terms) is a major cause of functional constipation (primary constipation), of which it is considered a subtype. It is characterized by difficult and/or incomplete emptying of the rectum with or without an actual reduction in the number of bowel movements per week. Normal definitions of functional constipation include infrequent bowel movements and hard stools. In contrast, ODS may occur with frequent bowel movements and even with soft stools, and the colonic transit time may be normal (unlike slow transit constipation), but delayed in the rectum and sigmoid colon.
Constipation is usually divided into two groups: primary and secondary. Primary constipation is caused by disrupted regulation of neuromuscular function of in the colon and the rectum, and also disruption of brain–gut neuroenteric function. Secondary constipation is caused by many other different factors such as diet, drugs, behavioral, endocrine, metabolic, neurological, and other disorders. There are main subtypes of primary constipation which are recognized, although overlap exists (see: Co-existence of different constipation subtypes): dyssynergic defecation, slow transit constipation (colonic dysmotility) and irritable bowel syndrome with constipation.
Obstructed defecation is one of the causes of chronic constipation. ODS is a loose term, consisting of a constellation of possible symptoms, caused by multiple, complex and poorly understood disorders which may include both functional and organic disorders. The topic of defecation disorders is very complicated, and there is a lot of confusion regarding terminology and classification in published literature. Occasionally some sources inappropriately treat ODS as a synonym of anismus. Although anismus is a major cause of ODS, there are other possible causes. Other authors use the term ODS to refer to defecatory dysfunction in the absence of any pathological findings (that is, a purely functional disorder).
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Defecography (also known as proctography, defecating/defecation proctography, evacuating/evacuation proctography or dynamic rectal examination) is a type of medical radiological imaging in which the mechanics of a patient's defecation are visualized in real time using a fluoroscope. The anatomy and function of the anorectum and pelvic floor can be dynamically studied at various stages during defecation. Defecating proctography was pioneered in 1945, during World War II.
Anorectal manometry (ARM) is a medical test used to measure pressures in the anus and rectum and to assess their function. The test is performed by inserting a catheter, that contains a probe embedded with pressure sensors, through the anus and into the rectum. Patients may be asked to perform certain maneuvers, such as coughing or attempting to defecate, to assess for pressure changes. Anorectal manometry is a safe and low risk procedure.
Anismus or dyssynergic defecation is the failure of normal relaxation of pelvic floor muscles during attempted defecation. It can occur in both children and adults, and in both men and women (although it is more common in women). It can be caused by physical defects or it can occur for other reasons or unknown reasons. Anismus that has a behavioral cause could be viewed as having similarities with parcopresis, or psychogenic fecal retention. Symptoms include tenesmus (the sensation of incomplete emptying of the rectum after defecation has occurred) and constipation.
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