The complex neural coordination and physiology of normal defecation has not yet been completely explained. A defecation event can be disturbed for many reasons, the most common being associated with pregnancy and childbirth, gynaecological descent or neurogenic disturbances of the brain-bowel axis. Causes of obstructed defecation are elucidated by functional imaging and functional investigations of the pelvic floor. Biofeedback treatment can be applied to paradoxal puborectal contraction (anismus), a coordination disturbance of pelvic floor muscles. A new surgical procedure has been developed for the treatment of rectal invagination and rectocele.