It is a broad term used to describe having difficulty passing stool through the rectum and anal canal (back passage) and the inability to achieve an adequate bowel movement. ODS can affect both men and women however it is more common in women.
Symptoms often include a feeling of incomplete emptying of the bowel after stool is passed with a need to return to the toilet several times after to pass further stool to clear the bowel fully. Often it is difficult to ‘wipe clean’ after a bowel movement. Prolonged or excessive straining when passing stool, or a need to assist the passage of stool either by supporting the perineum or vagina internally with a finger (digitation) or manual evacuation are not uncommon. It can be associated with passage of hard stools / constipation, or occasional leakage of stool after a bowel movement.
There are different causes for ODS, which could be either an internal rectal wall prolapse
(Intussusception), or prolapse of small bowel down into the space between the vagina and rectum (Enterocele), or bulging and herniating of the rectum into the vagina (Rectocele).
The initial measures to treat these symptoms are commonly by increasing your daily fibre intake and oral fluid intake, use of laxatives and glycerine suppositories to help achieving better bowel emptying. If the initial measures are not working, the use of rectal irrigation can be tried, which involves washing out the anal canal and rectum with water after a bowel motion to remove any stool that has not been passed naturally. Biofeedback can be helpful in more severe cases. This is a 12-week course of specialist physiotherapy to retrain the pelvic floor and is performed in the physiotherapy department. Biofeedback uses a combination of exercises and specially designed sensors to help stimulate the muscles within the pelvic floor helping you to both locate and strengthen or relax them. Approximately 60% of patients report a significant improvement in their obstructive symptoms with Biofeedback alone. It is also used before any surgery is undertaken to improve the overall outcome.
For those failing to improve with these measures and with evidence of a structural cause for ODS such as an intussusception or rectocoele, surgery such as a rectopexy, or rectocoele repair may be indicated.