Skip to main contentLast updated: 04-Nov-2026
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Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
GI & Proctology Surgeon
Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad · 18 years of experience
In short
Obstructed defecation means you feel the urge, yet stool will not come out easily. You strain, sit for long and still feel unfinished.
Two very different problems cause it. In one, the muscles of the pelvic floor tighten when they should relax. In the other, the bowel wall folds or bulges and blocks the exit.
Telling them apart comes before any treatment. Training helps the first problem. An operation is for the second, and only after simple care has been tried.
If tissue also comes out of the anus, read our rectal prolapse surgery page. This post explains why the bowel feels blocked and how the cause is found.
It is trouble getting stool out at the exit, not trouble with how often you go. The bowel may move well, yet the last step fails.
It is common in women, especially after childbirth. It is often called constipation and treated with stronger and stronger laxatives, which may not touch the real cause.
One question decides the treatment: is the exit blocked by muscles that will not relax, or by a structure that folds and traps stool?
| Feature | Muscle that will not relax | Structural fault in the bowel wall |
|---|---|---|
| What goes wrong | The pelvic floor muscle tightens when you strain, instead of letting go | The bowel wall folds into itself, or a bulge traps stool |
| Typical clue | Strong effort, no stool, and a tight feeling | Pressing on the vagina or anus to empty |
| What tests show | The muscle contracts or stays tight during straining | A fold, a bulge or a drop of the bowel on the X-ray |
| Usual first treatment | Retraining the muscle with a therapist | Simple care first, then a repair if needed |
| What to avoid | An operation, which will not fix the muscle | Years of laxatives alone |
Some people have both. In that case we treat the muscle problem first, then check what is left. An operation on a bowel whose muscle still will not relax tends to disappoint.
Both are folds or bulges of the rectal wall. Many are found by chance and need no treatment. They matter only when they trap stool and cause symptoms.
It is a sore on the inner wall of the rectum, caused by long straining and rubbing of the bowel wall. It is not a cancer.
| Point | What it means |
|---|---|
| Who gets it | Often a younger adult who strains a lot, spends long on the toilet or presses to empty |
| Symptoms | Bleeding, mucus, a feeling of incomplete emptying, and sometimes pain |
| The name | Misleading. There may be more than one sore, or a patch that is red or raised |
| How it is confirmed | A look with a scope and a biopsy, to rule out other conditions |
| Main treatment | Stop the straining and pressing, add fibre and fluid, and retrain the muscle if needed |
| When an operation helps | If a clear internal prolapse is driving it and habit changes have not worked |
The sore heals slowly. Changing toilet habits is the backbone of treatment, and patience matters.
A careful history and examination come first. We then choose only the tests that will change the plan.
| Step | What it shows | When it is used |
|---|---|---|
| History and examination | Whether the muscle relaxes when you strain, and whether a bulge is felt | Everyone |
| Scope of the rectum | Inflammation, an ulcer or a growth, with a biopsy if needed | If there is bleeding or mucus |
| Balloon test | Whether you can push out a small balloon in the usual time | When a muscle problem is suspected |
| Pressure test of the anus | Whether the muscles tighten instead of relaxing on straining | When the cause is still unclear |
| X-ray or MRI of emptying | Folds, bulges and how the pelvic organs move | Before any decision about an operation |
Read about how the pelvic floor is tested for more on these tests.
Almost everyone starts with simple care for several weeks. The next step depends on what the tests showed.
| Finding | Option we discuss |
|---|---|
| Muscle that will not relax | Biofeedback training, repeated and practised at home |
| A clear internal prolapse or bulge that traps stool, with symptoms that stay | A keyhole operation that lifts and fixes the rectum, called ventral rectopexy |
| A solitary rectal ulcer with a clear internal prolapse behind it | The same repair, after habit changes have been tried |
| A slow-moving colon with a normal exit | A different plan from an exit repair. Removing the colon is rarely right and needs very careful selection |
There are also operations through the anus that remove extra bowel wall, some using a stapler. They can cause urgency and other problems, and they are wrong for a muscle that will not relax. We explain the choices, and the likely gain, before you decide.
The pelvic floor works as one unit. If you also have a drop of the womb or bladder, or urine trouble, they should be looked at together.
A joint check by a bowel surgeon and a urogynaecologist can change the plan. We refer you if it helps. Read about the repair through the abdomen to see how the keyhole operation works.
Not always. In constipation the bowel moves slowly and you feel no urge. In obstructed defecation you feel the urge but cannot empty, however hard you strain. The two can coexist, and the treatment differs.
This is called splinting or digitation. It usually means a bulge, such as a rectocoele, traps stool, or the muscles are not relaxing. It is a clue worth telling your doctor about.
They help if the stool is hard, but they do not fix a muscle that will not relax or a bowel wall that folds over. Years of stronger laxatives without a proper test often leave people no better.
Most people do not, at first. Training and toilet habits come first. Surgery is considered only when a clear structural fault is found and a proper trial of simple care has not worked.
It is a sore on the inner wall of the rectum caused by long straining and the bowel wall rubbing on itself. The name is misleading, because there may be more than one. It causes bleeding and mucus, and a biopsy confirms it.
It is not a cancer and it is not known to turn into one. We still take a biopsy, because other conditions can look similar and must be ruled out.
Then a scalpel will not help, and an operation may even make things worse. Retraining with a therapist is the treatment, and it often works well.
For the full range of prolapse care, start at the rectal prolapse surgery page. For questions before you travel, call +91-63555-64601.
Dr Harsh Shah — Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad
Dr. Jivraj Mehta Hospital, Dr Jivraj Mehta Marg, Vasna, Ahmedabad 380007.
Consultations, review of reports and scans, operations and follow-up. OPD Monday to Saturday, 9 am to 5 pm.
Appointments: +91-63555-64601 · +91-63590-11009 · Hospital 079-2663 6363
Directions to the hospital · WhatsApp +91-63555-64601
Do you sit for a long time, strain hard and still feel the bowel has not emptied? You may be pressing on your anus or vagina to get stool out. Many people put up with this for years. Dr Harsh Shah will listen, examine you and work out what is really blocking you. Call, or send a message on WhatsApp. Call +91-63555-64601 Ask on WhatsApp
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