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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Magnetic resonance defecography assessment of obstructed defecation syndrome in patients with chronic constipation in a tertiary care hospital
Mohammad Haroon Or-Rashid, Anjuman Sultana, Nabila Khanduker, Tarik Alam Ony, MD Mosharraf Hossain, Junaidur Rahman, Mahmud Zaman Chowdhury, Wasih Uddin Ahmed, MD Nashir Uddin, Mohammad Sohel- Uzzaman
Mohammad Haroon Or-Rashid, Junaidur Rahman, Department of Surgery, Dhaka Medical College and Hospital, Dhaka 1000, Bangladesh
Anjuman Sultana, Department of Obstetrics and Gynaecology, Mugda Medical College, Dhaka 1214, Mugda, Bangladesh
Nabila Khanduker, Department of Surgery, Green Life Medical College, Dhaka 1205, Dhanmondi, Bangladesh
Tarik Alam Ony, Department of Surgery, Mackay Base Hospital, Queensland 4740, Australia
MD Mosharraf Hossain, Mahmud Zaman Chowdhury, Wasih Uddin Ahmed, MD Nashir Uddin, Department of Surgery, Mugda Medical College and Hospital, Dhaka 1214, Bangladesh
Mohammad Sohel- Uzzaman, Department of Casualty, Dhaka Medical College and Hospital, Dhaka 1000, Bangladesh
Author contributions: Or-Rashid MH conceived the study, collected and analyzed the data, and drafted and finalized the manuscript; Sultana A managed, coordinated, and supervised the research activity, and finalized the manuscript; Khanduker N reviewed and edited the manuscript, conducted the literature review, and prepared the draft; Ony TA conducted the literature review and contributed to drafting the manuscript; Hossain MM coordinated and supervised the research; Rahman J collected the data and contributed to drafting the manuscript; Chowdhury MZ prepared the results and reviewed the manuscript; Ahmed WU coordinated and supervised the research; Uddin MN collected the data and conducted the literature review; Uzzaman MS curated the data and contributed to drafting the manuscript; all of the authors read and approved the final version of the manuscript to be published.
Institutional review board statement: The study protocol was approved by Institutional Review Board of Bangabandhu Sheikh Mujib Medical University, Dhaka Bangladesh (No. BSMMU/2020/10217, Date 29-11-2020) and conformed to the provisions of the Declaration of Helsinki.
Informed consent statement: Informed written consent was obtained from all study participants before enrollment into the study.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The anonymized data collected for the study will be made available upon reasonable request to the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Anjuman Sultana, Postdoc, Department of Obstetrics and Gynaecology, Mugda Medical College, Khilgaon, Dhaka 1214, Mugda, Bangladesh.
anjumansultanaflora@gmail.com
Received: February 17, 2025
Revised: April 20, 2025
Accepted: May 8, 2025
Published online: May 28, 2025
Processing time: 99 Days and 17 Hours
BACKGROUND
Obstructed defecation syndrome (ODS) is a subtype of constipation that is considered one of the major pelvic floor dysfunctions affecting the aging population, particularly women over 50 seeking medical care. The condition is characterized by the urge to defecate but an impaired ability to expel the fecal bolus. ODS is associated with various anorectal abnormalities, which are not always apparent during a standard physical examination, requiring specialized imaging techniques for proper diagnosis.
AIM
To study the distribution of causes of ODS in patients with chronic constipation by magnetic resonance defecography (MRD).
METHODS
This observational study evaluated the causes of ODS in 57 patients with chronic constipation who presented to Bangabandhu Sheikh Mujib Medical University between July 2020 and June 2021. After obtaining institutional review board approval and informed consent, patients underwent history taking, physical exams, and relevant investigations. ODS was diagnosed using Rome III criteria, with colonoscopy ruling out organic causes. Standard MRD was performed in different phases, and images were analyzed by expert radiologists and reported in a standardized format.
RESULTS
Pelvic floor descent and anorectal junction descent were the most frequent findings, each present in 94.7% of cases. Rectocele was observed in 78.9% of patients, while vaginal or uterine prolapse was seen in 59.4% of females. Less common abnormalities included paradoxical contraction (7%), and there were no cases of sigmoidocele. Functional measurements showed significant differences in pelvic floor dynamics between rest and defecation, particularly in the H-line, M-line, and descent of pelvic organs (P < 0.05).
CONCLUSION
Pelvic floor descent and anorectal descent were the most common findings in patients suffering from ODS, followed by rectocele. Younger females (< 30 years) were most affected.
Core Tip: Obstructed defecation syndrome (ODS), is a common and complex digestive condition with multiple causes. Patients with ODS are usually characterized by constipation and a frequent urge to defecate but difficulty in passing stool. This study aimed to identify the types, causes, and severity of ODS in constipated patients using magnetic resonance defecography. The predominant findings were descent of the pelvic floor and anorectal region, with ODS being more common in females, particularly those < 30 years-old. It is recommended that young female patients be prioritized in ODS assessments, and that health policies be developed to improve management of ODS.
