ODS or Obstructive Defaecation Syndrome is a recently recognised bowel
evacuation disorder. The symptoms are severe straining and inability to open
the bowels even with the use of strong laxatives. The patient (usually female) has
often to manually assist evacuation. Women often have to insert a finger in
the vagina and push to empty their rectum. This syndrome causes great
discomfort, abdominal distension with cramps and distress.

There is often a history of other pelvic floor problems, such as urine stress
incontinence, difficulties with bladder evacuation, vaginal prolapse or
multiple childbirths.
This is because the pelvic floor operates as a common "platform" where several
organs (the bladder, the vagina, the rectum) are resting and when the pelvic
floor starts prolapsing multiple symptoms arise.

The cause is an internal intussusception of the rectum. Intussusception is the
sliding of part of the bowel in its own self, in the same way as the parts of a
folding telescope. It can happen in any part of the large or small bowel. In ODS
intussusception causes obstruction of the rectum.  The more the patient strains
the worse the obstruction becomes. In females the obstruction causes the
anterior part of the rectum to collapse towards the vagina causing a concurrent
rectocele. A general prolapse of the pelvic floor with other organ prolapse may
occur – cystocele (prolapse of the bladder), enterocele (prolapse of the small
bowel) etc.

ODS is diagnosed by performing a special radiology investigation called a
proctogram which demonstrates the pathognomonic images of rectal
intussusception and anterior rectocele.

The treatment is resection of the intussuscepting part of the rectum. This
relieves the obstruction and improves the emptying of the rectum.

The resection can be performed with the diathermy (electric knife) , however a
new method is STARR. The initials stand for Stapled Transanal Rectal
Resection and it is a method which uses a stapler instrument similar to that used
in stapled haemorrhoidectomy. Two firings of the stapler anteriorly and
posteriorly remove the prolapsing part of the rectum and join the rest together at
the same time (under general anaesthetic). The rectocele is usually obliterated in
this way as well.

STARR is still a new procedure and more time is necessary to assess the long
term results. However short term results have been reported so far to be very
encouraging. There is a small risk of developing the complications of bleeding,
urgency (usually settles quickly), incontinence (rare) and recto-vaginal
fistula (extremely rare).
ODS & STARR
(Obstructive Defaecation Syndrome and Stapled
Transanal Rectal Resection)