Prima facie, nothing appears easier than the diagnosis of chronic constipation. Nevertheless, in not a few cases, it may be an exceedingly difficult task to determine accurately the etiologic factor. Many cases are due to mechanical causes which, not infrequently, are never recognized or even suspected. With the improved modern methods of examination at our command, physical, gastric analysis, examination of the stool, roentgenology, and proctologic examination, to which is added the clinical subjective signs and symptoms, an accurate diagnosis can and should be made in the majority of cases.
No case of chronic constipation is diagnosed correctly or should ever be treated as such, until a thorough proctologic examination has been made. The rectum, in many cases, is found distended with feces, the patient not experiencing the slightest sensation of its presence and having no desire whatever for stool. This rectal stasis may be atonic in character, or it
GRAHAM AB. RECTAL CONDITIONS IN CHRONIC CONSTIPATION. JAMA. 1917;LXIX(18):1515-1520. doi:10.1001/jama.1917.02590450035013