9
Figure 5. Treatment Algorithm for Defecating Disorders
Defecatory disorder
Pelvic floor retraining
± dietitian, psychology
Follow
clinically
Repeat balloon
expulsion test
Improvement No Improvement
Defecating/
MR proctogram
Colonic transit
Abnormal Normal
Slow transit
constipation
Normal transit
constipation
Slow
Normal
Yes No
Consider surgery
Normal anal/
pelvic floor
relaxation
Abnormal anal/
pelvic floor
relaxation
Clinically significant
structural abnormality
Reassess biofeedback,
PRN suppositories,
enemas
Consider fallback
options
