Obstructive Defecation Syndrome: Anismus and Hirschsprung’s Disease

Abstract

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Obstructive Defecation Syndrome (ODS) is characterized by difficulty or inability to evacuate stool effectively, despite a normal or absent defecatory urge. It results from muscular dysfunctions—both striated and smooth—sensory deficits, or anatomical abnormalities like rectocele or rectal prolapse. Key symptoms include straining, incomplete evacuation, urgency, perineal heaviness, and self-digitization. Diagnosis is based on clinical symptoms and confirmed by defecography or anorectal manometry. Conservative treatment includes dietary changes, laxatives, and physical therapy. Biofeedback and posterior tibial nerve stimulation (PTNS) have shown high efficacy in improving coordination and muscle function. Anismus, a form of pelvic floor dyssynergia, and Hirschsprung’s disease, a congenital absence of enteric ganglia, are notable causes of ODS. Hirschsprung’s disease requires surgical correction, with physical therapy supporting postoperative recovery. A multidisciplinary approach is essential for effective management.