Do you also have difficulty going to the toilet? Let's learn more about Obstructed Defecation Syndrome!

Do you sometimes feel like you have difficulty passing stool when you go to the toilet? Do you feel dry, tight, and not quite finished? Or do you go without going to the toilet for several days? Maybe this is not just ordinary constipation. Today, let's talk about the medical term for this condition, Obstructed Defecation Syndrome. Although this is a bit of a long name, in simple terms, it is an obstruction or discomfort that occurs during defecation.

What is this difficulty in defecating? (What is `Obstructed Defecation Syndrome`?)

Simply put, Obstructed Defecation Syndrome (ODS) is a condition where you have to defecate but are unable to do so properly. There can be many reasons for this. Some are physical, meaning they are caused by mechanical obstructions inside your body. Others can be psychological.

A person with this condition may experience the following:

• Feeling like you can't go to the toilet whenever you want.
• I only have to go to the toilet once every few days, which means I don't poop often.
• Even after going to the toilet, you still feel like you haven't completely defecated.

This causes them to be constipated . Sometimes, the stool that is stuck inside can come out little by little without control. This is also called `(Fecal Incontinence)`. These people spend a lot of time on the toilet, waiting for the stool to come out, or they strain hard. Due to straining like this for a long time and passing dry, hard stool, the muscles and nerves involved in the process of defecation can be damaged. Then the situation becomes worse. Imagine, if you are trying to open a door and it is stuck, if we push harder, things like the hinges of the door can also be damaged, right? That's what happens here.

How does this condition affect your body?

ODS is not a single disease. It is like an umbrella. Under that umbrella, there are a number of different conditions that cause constipation and difficulty defecating. The common feature of all of these is the symptoms of constipation.

For doctors to diagnose constipation, two or more of the following symptoms must persist for 90 days :

• Straining more than 25% of times you have a bowel movement.
• The feeling of incomplete evacuation in more than 25% of bowel movements.
• Passing hard, dry stools more than 25% of the time.
• Having to use objects such as fingers to defecate more than 25% of the time.
• Defecation less than three times a week.

But these symptoms may only be the tip of the iceberg. There may be other underlying conditions that have not yet been discovered.

Chronic constipation can lead to many other problems over time. Sometimes, it's hard to figure out what caused it in the first place and what caused it later.

People who have difficulty passing stool may also experience other conditions such as:

• Pelvic floor dysfunction: The muscles and nerves in your pelvic area (the area below your belly button) don't work together properly to pass stool. Think of it like a team working together, but each person is doing different things.
• Organ prolapse: An organ in the pelvic area, such as the bladder, uterus, or intestines, that falls from its normal position, pushing on another organ or trying to come out of the body.
• Rectal hyposensation: The loss of the ability to sense the presence of stool or the need to defecate in the rectum. Much like losing the feeling of a tingling sensation in our hands.
• Pooping anxiety: Some people may consciously or unconsciously avoid defecating because of the hard, painful stools they experience. Just like if you touch something hot and burn yourself, you may be afraid to touch it again.

How common is this condition?

About 18% of the world's population, or 18 out of every 100 people, suffers from this widespread condition called bowel incontinence. It is especially common among women and middle-aged people . So know that you are not alone in this problem.

What are the symptoms of bowel incontinence?

A person with this condition may typically feel like this:

• I need to go to the toilet, but I feel like I can't.
• It is very difficult to defecate, sometimes with pain.
• No matter how hard I try, I feel like I haven't completely passed stool.
• It feels like something is stuck in the way of the stool.

This may also require you to do the following:

• Straining to defecate.
• Having to wait a long time for the stool to come out.
• Sometimes you have to use your fingers to help yourself pass stool. (Don't be embarrassed about this, it's part of the condition.)
• The use of laxatives or enemas to expel stool.

This situation can cause other things like:

• Constipation.
• `Fecal incontinence` (uncontrolled bowel movements).
• A constant inconvenience.
• Mental conditions such as anxiety or depression, because this has a major impact on daily life.

The most common complaints are:

• The rectum feels swollen or injured.
• Abdominal pain and distension.
• Anal pain.
• Nausea, fatigue, and loss of appetite.

Why can't I go to the toilet properly? What are the reasons?

There can be many causes of ODS. These can be organic or mechanical . That is, things like anatomical defects or physical blockages in the passage of feces. On the other hand, there are also functional causes . These are related to the functioning of the brain and nervous system.

Often, both types of causes can coexist. Sometimes, one type of cause can lead to the other.

Mechanical reasons:

• Perineal hernia: Organs in your abdomen or pelvic area protrude through the pelvic floor.
• Pelvic organ prolapse: An organ in your pelvic area that slips out of its normal position and pushes into your anus or rectum. For example:
• Rectal prolapse: Part of the rectum protrudes through the anal opening.
• Rectal intussusception: The upper part of the rectum collapses inward like a telescope.
• Rectocele (weakened rectal wall): In women, the wall between the anus and vagina becomes weak, causing the anus to protrude into the vagina. This can cause stool to become trapped in the protruding area.
• Solitary rectal ulcer syndrome: The development of one or more ulcers in the rectum. This can be caused by frequent straining.

Functional reasons:

• Anismus (dyssynergic defecation): In order to pass stool, the sphincter muscles around the anus need to relax. They also need to be pushed by the abdominal muscles. This process is not coordinated properly, and instead of relaxing, the muscles tighten. It's like trying to open a door and closing it even harder.
• Rectal hyposensitivity: You should be able to feel the sensation of your rectum filling with stool. Damage to the nerves can reduce this sensitivity, preventing the brain from sending signals to tell you to have a bowel movement.
• Psychological disorders: Anxiety, depression, certain phobias, OCD (obsessive-compulsive disorder), and eating disorders can all affect this. This is a good example of how mental issues can affect the body.

Any of these could be a primary cause of ODS, or a secondary effect caused by ODS.

Also, the following factors can contribute to these conditions:

• Pregnancy and childbirth.
• Surgeries performed in the pelvic area.
• Injury or abuse caused by an accident.

How exactly do doctors diagnose this condition?

When you see a doctor, they will first ask you about your symptoms. They may also use a scoring chart to measure the severity of your symptoms.

While these symptoms can help you determine if your constipation is chronic, to accurately diagnose ODS, your doctor will need to make sure that simple causes (such as a temporary change in diet) are not causing it. This will involve taking your medical history and performing several tests.

What tests are done to diagnose this condition?

After understanding your symptoms, your doctor may recommend tests like these to learn more:

• Digital Rectal Exam: This is usually the first test done. The doctor will use a gloved, lubricated finger to examine the rectum. This can give you an idea of ​​the size of the rectum, the cause of the pain, whether the organs are prolapsed, and how well the muscles are working. This may seem a little uncomfortable, but it is a very important test.
• Defecography (X-ray or MRI of the bowel movement): This involves taking pictures of the inside of your bowel movements. The doctor will insert a special substance (such as barium) into your rectum. Then, you will be asked to pass it as if you were defecating. This is done in a special private imaging room. The doctor will watch your internal organs on a computer screen. This can help determine the shape of your rectum, the function of your muscles, and any obstructions that may be blocking your passage of stool.
• Anorectal Manometry: This test measures how well your muscles and nerves work together to help you pass stool. A thin tube (catheter) with a small balloon attached is inserted into your anus, and the balloon is filled with warm water. The other end of the tube is connected to a machine that measures muscle activity. This can measure the pressure, sensation, and coordination of your anus.

You may feel a little scared or uncomfortable when you hear about these tests. But they can be very helpful in finding the exact cause of your condition. Ask your doctor any questions you may have.

What are the treatments for this?

The causes of ODS are usually complex, with many interrelated factors, so treatment is often holistic and conservative.It is done in a way. It is unlikely that this can be cured with just one surgery. Even if surgery is recommended, and it corrects a physical defect, it does not always result in a complete cure. Symptoms may persist or recur. Because there are other factors that need to be addressed, perhaps not yet discovered.

These are the first things doctors recommend for everyone:

• Adding more fiber to your diet: About 30-40 grams per day. Things like legumes, vegetables, fruits, and whole grains.
• Drink more water: more than 2 liters per day.
• Stool softeners or laxatives , home enemas , and colonic irrigation if necessary.
• Yoga and guided relaxation techniques can help relax the pelvic floor muscles and reduce stress.

For those with symptoms caused by nervous system or psychological causes (about two-thirds of people with this condition are affected by such causes):

• Biofeedback therapy: This is particularly useful for conditions such as anismus (inability to relax the anal opening muscles) and pelvic floor dysfunction. In this, your body's activity (such as muscle contractions) is shown to you through a machine. You can then train yourself to consciously control that activity.
• Psychotherapy: If necessary, seek help from a psychiatrist or counselor. This can treat conditions such as anxiety, depression, and fear of defecation.

For physical problems (such as anatomical problems such as prolapse): If other treatments don't help, doctors may recommend surgery. There are several types of surgery that can be performed:

• Posterior colporrhaphy for rectocele: To restore and strengthen the prolapsed rectal wall.
• Stapled transanal rectal resection (STARR) for rectocele and intussusception: A surgery to strengthen the anterior wall of the rectum.
• Rectopexy: For rectal prolapse, the rectum is returned to its normal position and fixed. Sometimes, a mesh is used for this. Sometimes, part of the colon may also need to be removed during this surgery.

Remember, surgery is always a last resort. Your doctor will carefully examine your condition and recommend the treatment that is best for you.

What will the future hold for those with this condition?

Conservative treatments can help about 30% of people see a cure or a reduction in symptoms. Lifestyle changes (diet, water, exercise) and home treatments (medication, enemas) may need to be continued, but they can really provide relief.

Treatments like biofeedback and psychotherapy take time and dedication to produce results, but their benefits can be long-lasting. Results from surgery vary. Surgery appears to be more effective when combined with other treatments.

Difficulty passing stool is a problem that needs immediate attention. But it can be difficult to figure out what's causing it. You'd be surprised how many systems in our body – even the brain – are involved in the process of passing stool!

Fortunately, many of the treatments that doctors recommend for ODS can also be helpful for anyone with regular constipation. You can start with lifestyle changes, home remedies, and therapies today. But it’s always a good idea to see a doctor for a checkup. He or she can rule out other medical conditions or physical problems that could be contributing to your condition and treat those as well. And, after learning more about your condition, he or she can talk to you about your diagnosis.

Finally, remember this !

Okay, so here are some things you need to remember from what we've talked about today:

• Urinary incontinence (UDI) is a somewhat complex condition that can be caused by more than one cause.
• If you have difficulty going to the toilet, your bowels are dry, and you feel like you haven't passed stool, don't just ignore it.
• If you have these symptoms, don't be shy or afraid, see a doctor. If you find the cause and get the right treatment, you can get out of this situation.
• Simple lifestyle changes (high-fiber foods, water, exercise) can make a big difference.
• Sometimes special treatments like `Biofeedback` or surgery may be necessary. Your doctor will advise you about this.
• You are not alone in this problem. Many people suffer from this condition. So stay strong and follow your doctor's advice.

Wishing you good health!

` Constipation, Difficulty Defecating, Obstructed Defecation Syndrome, Rectal Disease, Pelvic Floor Weakness, Dryness, Stool Treatment