Guideline on Pelvic Floor Disorders: consensus on Obstructed Defecation Syndrome (ODS)
| Journal | Volume 89 - 2026 |
| Issue | Fasc.2 - Guidelines |
| Author(s) | C. Van de Bruaene 1 2 3, H. De Schepper 4, M. Surmont 5, D. Van de Putte 6, S. Van den Broeck 7 8, G. Bislenghi 2 9, K. Boon 10, P. Casteels 11, J.-B. Cornille 12, D. De Looze 13, M. A. Denis 14, A. François 15, I. Gijsen 16, J. Geldof 13, B. Van Geluwe 17, I. Geraerts 18 19, M. Hanssens 20, S. Kindt 5 21, N. Komen 7 8, D. Meerhout 22, S. Nullens 4, N. Poortmans 23, P. Pletinckx 24, K. Raymenants 1 2, H. Ruymbeke 25, A. Segaert 26, S. Stockman 27, J. Stijns 23, T. Van Aggelpoel 28 29, L. Vandenplas 18 19, P. Roelandt 1 2 |
| Full article |
 PAGES 385-405 VIEW FREE PDF |
| DOI | 10.51821/89.2.15231 |
|
Affiliations: (1) Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
(2) Translational Research in Gastrointestinal Diseases (TARGID), Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium (3) Department of Gastroenterology and Hepatology, AZ Maria Middelares, Gent, Belgium (4) Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium (5) Department of Gastro-enterology and Hepatology, University Hospital Brussels (UZ Brussel), Brussels Health Campus, Brussels, Belgium (6) Department of Gastrointestinal and Colorectal Surgery, University Hospital Ghent, Gent, Belgium (7) Department of Abdominal, Pediatric and Reconstructive Surgery, Antwerp University Hospital, Edegem, Belgium (8) Antwerp ReSURG, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium (9) Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium (10) Department of Gastrointestinal and Colorectal Surgery, Noorderhart Mariaziekenhuis, Pelt, Belgium (11) Department of Gastroenterology and Hepatology, AZORG, Aalst, Belgium (12) Department of Gastrointestinal and Colorectal Surgery, VITAZ, Sint-Niklaas, Belgium (13) Department of Gastro-enterology and Hepatology, Ghent University Hospital, Gent, Belgium (14) Department of Gastro-enterology and Hepatology, Cliniques universitaires. Saint-Luc, Brussels, Belgium (15) Department of Gynecology, Noorderhart Mariaziekenhuis, Pelt, Belgium (16) Department of Gastro-enterology and Hepatology, Noorderhart Mariaziekenhuis, Pelt, Belgium (17) Department of Gastrointestinal and Colorectal Surgery, AZ Groeninge, Kortrijk, Belgium (18) Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium (19) Department of Rehabilitation Sciences, KU Leuven, Belgium (20) Department of Gastro-enterology and Hepatology, AZ Sint-Lucas, Gent, Belgium (21) Vitality Research Group, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium (22) Department of Physiotherapy, University Hospital Brussels (UZ Brussel), Brussels Health Campus, Brussels, Belgium (23) Department of Gastrointestinal and Colorectal Surgery, University Hospital Brussels (UZ Brussel), Brussels Health Campus, Brussels, Belgium (24) Department of Gastrointestinal and Colorectal Surgery, AZ Maria Middelares, Gent, Belgium (25) Department of Gastro-enterology and Hepatology, VITAZ, Sint-Niklaas, Belgium (26) Department of Gynecology, AZ Maria Middelares, Gent, Belgium (27) Department of Physiotherapy, University Hospital Ghent, Gent, Belgium (28) Faculty of Medicine and Health Sciences, University of Antwerp, Belgium (29) Department of Urology and Urological Rehabilitation, Antwerp University Hospital, Belgium |
|
Background and aims: Obstructed defecation syndrome (ODS) is a multifactorial condition that significantly impairs quality of life and presents diagnostic and therapeutic challenges due to the interaction of functional and anatomical factors. This initiative aimed to develop a Belgian consensus and a diagnostic–therapeutic algorithm to support effective clinical management of ODS. Methods: A Belgian steering group of gastroenterologists and colorectal surgeons (n=6) conducted a Delphi consensus process. Based on a structured literature review, 82 statements were drafted and discussed during three online voting rounds. Consensus was defined as ≥80% agreement, and evidence strength was graded using the GRADE system. Results: Thirty-one experts participated, including gastroenterologists, colorectal surgeons, gynecologists, and physiotherapists. Sixty-two final statements were formulated, of which 46 were endorsed. ODS was defined as a disorder of anorectal evacuation, with functional and structural components often coexisting. Symptoms overlap with functional constipation, IBS-C, and fecal incontinence, and quality of life is substantially impaired. Diagnosis requires multimodal evaluation, including digital rectal examination and anorectal testing. First-line treatment consists of conservative measures such as lifestyle optimization, laxatives, and pelvic floor re-education. Surgery is reserved for selected patients with refractory symptoms and significant anatomical abnormalities. Tailored surgical approaches are supported for rectocele, rectal prolapse, and pelvic organ prolapse, whereas sacral nerve stimulation is not routinely recommended. Conclusion: These consensus statements provide practical guidance for the diagnosis and management of ODS. Conservative therapy remains the cornerstone, with surgery reserved for selected cases. Areas lacking consensus warrant further research. Keywords: ODS, obstructed defecation syndrome, pelvic floor physiotherapy, consensus, Delphi, surgical treatment. |
|
© Acta Gastro-Enterologica Belgica. PMID 42417642 |