Assessment and treatment of obstructed defecation

Defecation may be considered as "the last taboo". The inability to defecate, or to achieve it only by digital evacuation, has never been a popular topic among patients and doctors. The extensive development of tests in laboratories studying colorectal disorders during recent years, however, has made it possible to study the different parts of the mechanism for maintaining continence. Since constipation is a disorder of this mechanism, namely a disorder of rectal evacuation, application of these tests on constipated patients is logical. Certainly surgery, either colectomy or sphincter division, is not the solution, nor is the injection of muscle weakening solutions. Biofeedback, however, seems to be a logical treatment. Development of new functional tests and strategies is needed to enable a better understanding of the problem. Collaboration between surgeon and psychologist has proved valuable and is recommended.