The symptoms and general points in the diagnosis of the common affections of the colon, rectum and anus are herewith grouped together in order to assist in understanding the correlative position of these diseases.

Local and Reflex Symptoms in this region are, in some instances, so accurately defined that one hardly needs more than a suggestion of the chief symptom to form an idea as to the area affected. For instance, severe pain after defecation is almost pathogenic of fissure in anew and is generally located by the patient in the anal orifice. There may be at the same time reflex pain, described as a soreness in the buttocks or extending down the inner side of the legs. Many individuals suffering from an anterior median fissure will unconsciously empty the bladder in response to an impulse originated at that point - this is also reflex. It is the common experience of surgeons to have to catheterize patients after hemorrhoid operations, due to the traumatize in the rectum affecting the nerves of the bladder. A hard kick or an injury to the perinea region generally inhibits the physiological act of urination.

A Melancholic Condition of the mind is generally noted in persons suffering from protracted rectal and anal diseases. This mental condition is probably due to the effect of pain and embarrassment. They usually hesitate to discuss the subject of their trouble with others and choose to bear their suffering without advice or sympathy. The mental conditions of persons suffering from painful rectal diseases, such as fissures, hemorrhoids and ulcerations, is quite characteristic and constant. There is a depressed state of mind which depicts a most forlorn, helpless and discouraged individual, particularly when repeated failures of cure have been experienced.

These sufferers are often incapacitated for the ordinary occupations of life, and, when men of business, sometimes fear the loss of their employment from the disinterest in commercial affairs due to their misery. Those suffering from marked constipation, associated with fissures or painful hemorrhoids, probably suffer from a mental depression most frequently. Irritability of temper, sleeplessness and indigestion usually accompany prurient an Constipation is a relative term used to denote the slow movement of the bowel contents.

Constipation, fecal impaction and partial intestinal obstruction may be confused with acute constipation. The causes may be classified as deformities of the rectum, anus and intestine, over-distention of the intestine from gases, deficient food supply, excessive excretions from the skin and kidneys, enterprise, weak abdominal muscles, painful affections about the anew-rectal region, and habit. The symptoms are due largely to auto-intoxicate son in the form of indigestion, flatulence, and eye-strain in the adult. Children and infants suffering from constipation, either in the acute or chronic form, are liable to convulsions, night terrors, day terrors, teeth grinding, bed wetting, and hypochondria’s, reflex symptoms brought on by the intestinal disturbances.

Incontinence of Feces is sometimes mistaken for diarrhea when the description of the ailment is accepted by the physician without due consideration of the causes other than the catarrh diseases. It is common in transverse myelitis and in all paraplegic conditions due to an injury of the spine in the lumbar region. Sometimes it occurs as a transient symptom in the severe prostration associated with acute and chronic diseases, as often manifested during the course of typhoid fever, cholera infant um, tuberculosis, and some cases of acute Castro-entering infection and pneumonia. Incontinence of feces is a common accompaniment of dynamic nervous condition arising from any cause.

Incontinence resulting from any of these causes may later change to an obstinate constipation. The relaxed and inactive sphincters may allow the escape of the bowel contents, but by its inactivity, associated with the loss of sensation in the rectum, permit the feces to mass themselves, causing an impaction. This condition is then aggravated by the lessened secretion of mucus and the mass becomes caked. Incontinence of feces, associated with incontinence of urine, is one of the symptoms of a Jacksonian epilepsy and helps to distinguish it from other similar seizures.

Painful Defecation is usually associated with all the diseases in or about the anal canal and the lower portion of the rectum. The degree of pain varies with the disease. Fissure or thrombotic hemorrhoids located on the much-cutaneous junction almost without exception give the most pronounced history of pain. Proctorial of the chronic types do not cause more than a soreness at the time of defecation. The fear of pain at defecation is a common cause of apparent constipation in children, and in turn tends to aggravate the primary affection, as when the hard-retained stool is evacuated, tearing or bruising a fissure. The pain may last for an indefinite time, often bringing about a general nervous reflex disturbance in the form of indigestion, and interference with nutrition.

Painful defecation is probably more commonly associated with hemorrhoids than any other ailments as they are the most frequent in occurrence, but the pain is not of the severe, cutting type manifested with ulcer or fissure, excepting when the hemorrhoid is strangulated or of the thrombotic type. The acute onset of the thrombotic hemorrhoid commonly suggests an abscess formation.

Rectal Tenements is manifested by the constant, more or less painful, desire to empty the rectum. The phenomenon resembles the colicky expulsion efforts of colonic peristalsis in dysentery. It may be a symptom of an affection located in the rectum alone or partake of a general inflammation of the colon, sigmoid and rectum.

This symptom occurs with nearly all diseased conditions which excite an irritating discharge in or above the rectum, as prolapse, ulceration, polyp insusceptible, malignant and non-malignant growths. Foreign bodies cause a direct traumatize to the mucous membrane and excite expulsion efforts. Often the symptom is associated with the discharge of blood, pus and mucus. The condition is not always associated with liquid evacuations from the rectum as the fecal discharges may be natural in consistency until changed by the local inflammation.