Obstructed defecation or constipation is broadly defined as the inability to evacuate contents from the rectum and is accompanied by symptoms of dyschezia and a subjective sensation of anal blockage during defecation. Outlet obstruction may be caused by organic or functional diseases and only a thorough diagnostic can identify the causes. Mechanical causes include rectocele, rectoanal intussusception, descending perineum syndrome, solitary rectal ulcer syndrome, mucosal rectal prolapse, enterocele, and sigmoidocele. The functional diseases include disorders of rectal sensation and pelvic floor dyssynergia. The diagnostic workup of patients with obstructed defecation includes morphologic techniques, such as defecography and magnetic resonance imaging (MRI), to evaluate anatomical abnormalities of the anorectum and pelvis during evacuation, functional techniques, such as anorectal manometry (AM) and neurophysiological tests (sphincter electromyography, latency of the bulbocavernosus reflex, evoked potentials), to evaluate motor and sensory dysfunction of the anorectum. At the present time, AM is extensively used to identify the pathophysiological mechanisms of anorectal obstruction in constipated patients but its clinical usefulness is debated.
Obstructed defecation is an ‘‘iceberg syndrome’’, because it is indicative of multiple anatomical and functional disorders which are both evident and occult, and each patient has more than one disorder. A mix of organic and functional disorders may be detected, without having any specific relationship with symptoms and signs of OD. Because of this complexity, multiple diagnostic tools are required, one of which is AM that can provide data which can better define the athophysiological mechanisms of OD. Although the wide range of normal values results in high variability of manometric data with a low negative predictive factor, our study presents a number of findings that support the usefulness of anorectal manometry. Measures of anal resting pressures can identify those patients (25.3%) who exhibit a significant impairment of anal tone. For example, 44 patients (11.6%) had a low mean anal resting pressure, and lower anal pressure profiles are positivelyrelated to grade 3 POP-Q (qs 0.63; P\0.01). Nevertheless, anal hypertonia may be detected in some patients (5.8%). These reports confirm the phenotypic variability of OD, as suggested by Bharucha et al. . One obvious consideration is that variations in anal resting pressure may influence therapeutic options because the borderline for fecal incontinence probably due to a sphincter lesion.
One possible solution is the squat stool that can help ensure that the puborectalis muscle can be further relaxed for fecal waste elimination. In the human body, the colon transports the fecal waste products to the rectum for removal. Just before reaching the rectum for waste disposal, the colon has a natural kink that helps to maintain continence. Normal sitting positions will only partially relax the puborectalis muscle and this will block the flow of fecal waste up to a certain point. And because of this, most individuals stain and use excessive force to excrete their waste products. Some will also have hemorrhoids due to the constant strain. Actually, for some people, instead of thinking about how to get rid of hemorrhoids, it would be a good idea to think of how to eliminate constipation.