It is vital to emphasize that patients who may have have defaecation difficulties for years [with some recent worsening of symptoms] may in fact suffer from other organic diseases which may be serious.

Once in a while a patients with recent severe ODS syptoms that appeared on a background of long standing ODS symptoms, will be discovered to have pelvic malignancy. It is more commoner in this situation to find ovarian malignancy, often as a pelvic mass on one side pressing on the sigmoid and / or rectum. Less frequently, an ovarian malignancy may cause extrinsic compression from encircling the lower bowel. Large benign ovarian or broad ligament cysts can also be the culprit.

Even in ladies who have had bilateral salpingo-oophorectomy, it is possible to have gynecological causes arising from ovarian remnants left on the side wall of the pelvis during the original gynaecologic operation.

The list of potential causes include:

• Ovarian Cancer
• Primary peritoneal cancer in pelvis [many of these are actually ovarian cancer originating from an ovarian remnant left behind on the pelvic side wall following a supposedly total abdominal hystrectomy & bilateral salgingo-oophorectomy previously]
• Ovarian cysts
• Broad ligament cysts
• Low sigmoid cancer
• Benign sigmoid strictures secondary to diverticular disease or Crohn's

This is why it is vital for all patients with a new diagnosis of ODS to have a minimum of a pelvic US & flexible sigmoidoscopy. Most patients should have an abdominal & pelvic US or CT as well as full colonoscopy.