الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Constipation is a common clinical problem that comprises a constellation of symptoms that include excessive straining, hard stools, feeling of incomplete evacuation, use of digital maneuvers, or infrequent defecation. Obstructed defecation (OD) occurs in about 7% of the adult population. Different pathophysiological mechanisms, either functional or anatomical, eventually lead to OD. Defecography, balloon evacuation test, manometry, electromyography, colonic transit time measurement manometry play an important role to quantify the problem. Different mechanisms can eventually lead to OD. A defective rectal filling sensation as in idiopathic megarectum and / or megacolon, or an impaired rectal sensation due to psychological factors or cerebral pathology can lead to OD. The expulsion can be inefficient due to a functional or mechanical outlet obstruction. The loss of ganglia in Hirschsprung<U+2019>s disease inhibits relaxation of the internal anal sphincter (IAS). Absence of relaxation or even paradoxical contraction of the striated pelvic floor muscles is noted in anismus. Dissipation of the force vector at straining is a major cause of OD in patients with a rectocele, descending perineum syndrome and rectal prolapse. Assessment of the complex pathophysiology behind the complaint of OD allows the surgeon to provide the patient with realistic expectations. Different surgical techniques have been described and validated for the treatment of prolapse of the middle and posterior pelvic compartment Biofeedback aims at training the pelvic floor muscles to relax, sensory training with a rectal balloon, behavioural relaxation and defecation of simulated stool.