in many patients [probably most], ODS symptoms are secondary to the total sum of a multitude of factors. It is possible to judge the impact of some of these factors such as severe diverticular disease and fixed bends in the pelvis [many following hystrectomy] by flexible sigmoidoscopy / colonoscopy. During laparoscopy the difficult dissection of some acute bends in the sigmoid stuck laterally or in front of the rectum, serves to emphasize their contribution to symptoms.
With progressive deterioration of the pelvic floor & prolapse, some of the bends become more acute & thus more symptomatic. A typical sequence is seen in the following Flash animation [click to start].