Evaluation of Obstructed Defecation

Publication Date: November 12, 2018
Last Updated: March 14, 2022

RECOMMENDATIONS

No specific symptom, physical examination finding, or imaging finding is sensitive and specific for obstructed defecation.
6731
Treatment decisions should be based on symptoms rather than findings on imaging.
6731
In most women with bulge symptoms and posterior vaginal wall prolapse, no imaging is required before surgery.
6731
Imaging may be most helpful in cases in which symptoms do not match physical examination findings (eg, defecograpy can show dyssynergic pelvic floor contractions in a woman with defecation dysfunction).
6731
Anterior rectoceles seen on imaging that are not symptomatic do not need treatment.
6731

Small bowel in the posterior cul-de-sac (enterocele) is found in healthy, asymptomatic women and should not be considered pathologic.

6731
MRI, ultrasound, and fluoroscopy defecography provide functional studies of pelvic organs.
6731
Imaging studies of defecation are most physiologic when done in a sitting position.
6731
MRI is the best modality to visualize soft tissue injury.
6731
Slow-transit constipation should be ruled out in patients with infrequent bowel movements, refractory to laxative or other conservative measures.
6731
Patients with a recent and persistent change in bowel habits, excessive straining or a sense of incomplete evacuation, abdominal pain, rectal bleeding, weight loss, and anemia have risk factors for colorectal cancer and warrant endoscopic gastrointestinal evaluation.
6731

Recommendation Grading

Overview

Title

Evaluation of Obstructed Defecation

Authoring Organization

American Urogynecologic Society

Publication Month/Year

November 12, 2018

Last Updated Month/Year

January 23, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Review techniques used to evaluate constipation and obstructed defecation, with a special focus on the relationship between obstructed defecation, constipation, and pelvic organ prolapse.

Inclusion Criteria

Female, Adult, Older adult

Health Care Settings

Hospital, Long term care, Operating and recovery room, Outpatient

Intended Users

Medical assistant, nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Management, Treatment

Diseases/Conditions (MeSH)

D007415 - Intestinal Obstruction, D056887 - Pelvic Organ Prolapse, D003672 - Defecation

Keywords

obstructed defecation, anorectal obstruction, chronic constipation, complete rectal evacuation

Source Citation

Ridgeway, B. M., Weinstein, M. M., & Tunitsky-Bitton, E. (2018). American Urogynecologic Society Best-Practice Statement on Evaluation of Obstructed Defecation. Female Pelvic Medicine & Reconstructive Surgery, 24(6), 383–391. doi:10.1097/spv.0000000000000635