Defecation Difficulty or Constipation?

An important part of breech diseases cannot be diagnosed due to the fact that some complaints that surgeons do not ask and patients cannot say because they are embarrassed are not investigated. When patients express that they are “constipated”, they actually mean that they cannot defecate, completely empty, go to the toilet frequently due to incomplete emptying, and sometimes remove their stools with their hands. Your closest relative has been taking medicine for maybe 20 years, and is floundering in despair and darkness with his own troubles. Patients who cannot empty their stools (Rectocele) because the intestine hangs inside itself, intertwined (intussusception) or because the last intestine balloons in women (Rectocele), go to the toilet frequently, stay in the toilet for a long time, push, throw a little slimy stool, but somehow pass the stool, mistaking it for a feeling of defecation. Their social life is paralyzed because they cannot evacuate.

How is defecation difficulty or constipation classified?

Stool difficulty is also called dyschesia, constipation, dyssynergic defecation. Rome III criteria. According to these criteria, at least two of the following items must have been present for 3 months and the patient’s complaints must have started at least 6 months ago.

Rome III criteria for defecation difficulties

Complaints should have started 6 months ago and have been persistent since the last 3 months.

Failure of the balloon expulsion test

Evidence of defecation difficulty by defecography

Determination of pelvic floor muscle contraction defect by anal manometry, anorectal electromyography or anorectal EMG

Proof of pushing defect by anal manometry or defecography

Rome III criteria for defecation difficulties

Fewer than three defecations per week

Excessive straining in at least 25% of defecations

Solid and bulky stools in at least 25% of defecations

Sensation of incomplete evacuation in at least 25% of defecations

A feeling of being stuck or blocked in at least 25% of defecations

Need for finger support in at least 25% of defecations (e.g. emptying with fingers or defecation by supporting the pelvis or pelvic muscles)

Inability to pass soft stools without using stool relaxants or softeners (laxatives)

Having symptoms of weak irritable bowel syndrome (IBS)

American Gastroenterological Society (ACG) criteria for defecation difficulties

Presence of at least three of the following symptoms within the past year

Fewer than three defecations per week

Difficulty defecating that requires excessive straining

Absence of feeling of defecation

Incomplete evacuation of stool

Hard and small pieces of defecation

Presence of long defecation times

Finger support required for defecation

In which situations is defecation difficulty seen?

insufficient fluid intake

Insufficient fiber intake



breech crack


Hypothyroidism (underactive thyroid gland)

Irritable bowel syndrome (IBS)

bowel cancer

Hirschuprung’s disease

Chagas disease


Multiple sclerosis (MS) disease

Parkinson’s disease

be paralyzed


breech prolapse (rectal prolapse)




Calcium excess

low potassium

Urea excess (uremia)


Overwork of the parathyroid gland (hyperparathyroidism)


What kind of tests are done in case of defecation difficulties?


large intestine x-ray

Anorectal manometry

Defecography (video-defecography, CT defecography, MRI defecography)

What does obstructive defecation mean?

Forced emptying of the stool in the rectum, which is the last part of the large intestine, or inability to empty it completely is called ‘obstructive defecation’.

What causes obstructive defecation?

During a healthy act of defecation, the involuntary muscle of the internal breech (internal anal sphincter) relaxes, and the voluntary muscle of the outer breech (external anal sphincter) and the pelvic floor muscles relax. Pelvis or roof bone floor or pelvic floor; It consists of the levator ani muscle, the coccygeal muscle, and connective tissue. Levator ani muscle; It consists of the pubococcygeus muscle, the puborectal muscle, and the iliococcigeus muscle. These muscles are responsible for the contraction and relaxation movements of the breech, urinary tract (urethra), prostate and female organ (vagina). Cameron et al. In the study, it was reported that 1/3 of women with breech prolapse (rectal prolapse) and defecation problems experienced urinary incontinence. Similarly, Morgan et al. In the study, it was reported that 1/3 of women with defecation problems experienced gas and stool incontinence.

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