European Guidelines on Multidisciplinary Management of Obstructed Defecation Syndrome-ESCP, UEG, ESGAR, EAGEN, ESGENA, ESNM and ESPCG.

In 30 seconds

These European multidisciplinary practice guidelines address diagnosis and management of obstructed defecation syndrome (ODS). A guideline group representing seven scientific societies and patient representatives developed PICO-based questions, reviewed the literature systematically, and graded evidence using GRADE. The resulting 28 statements cover diagnostic tests, conservative care, and surgical approaches; 22 are based on expert opinion, while the remaining statements draw on moderate, low, or very low quality evidence. The guidelines recommend multidisciplinary assessment, conservative treatment initially, and surgery only for selected patients with persistent symptoms after conservative management.

Key findings

• The guideline contains 28 statements: 1 supported by moderate, 2 by low, and 3 by very low grade evidence; 22 are expert opinion.
• Multidisciplinary assessment is recommended throughout the diagnostic and therapeutic pathway.
• Conservative treatment is the initial strategy; biofeedback is recommended before surgery for patients with dyssynergic defecation who do not respond to dietary and laxative treatment.
• Surgery is reserved for selected patients with persistent symptoms after conservative treatment and should follow multidisciplinary pelvic floor evaluation.

Why it matters

ODS care involves diagnostic testing and treatment options across several disciplines. These guidelines provide a shared framework for coordinating assessment and sequencing care, while making clear that much of the evidence is limited. Their emphasis on individualized decisions and multidisciplinary evaluation is important when considering interventions whose benefits are not strongly established.

What to keep in mind

Evidence supporting many recommendations is limited: 22 of the 28 statements are expert opinion, and only one is based on moderate grade evidence.