Stricture of this pathological nature seldom exists by itself and there is usually an abscess or pocket of broken-down tubercular tissue from which a fistulous tract will ramify into the neighboring tissue or encircle part of the rectum. Therefore, the general symptoms of tuberculosis, with temperature, hectic flush, and debility, are present with those strictures which assume proportions sufficient to give symptoms of obstructions. Tubercular ulcer may be present by itself in the rectum, but causes none of the symptoms ascribed to stricture.

Ulceration of the rectum may be due to secondary hypertrophy, catarrh proctorial, kidney, heart or lung diseases; to diabetes, follicular proctorial, cancer, tuberculosis, syphilis, Chandroids, traumatizes or dysentery, any of which may cause stricture.

Spasmodic or phantom stricture of the rectum is a condition which is probably not a reality. The condition described in ray opinion is the contraction of the valve of O’Brien, at the junction of the rectum and sigmoid. This spasm or apparent stricture is a common observation to those making use of the proctorial or kaleidoscope and may be observed at one time in the same patient and at another time may be UN-discernible

The Hypertrophy of Houston's valves. This condition arises from hypertrophy catarrh inflammations, ulcerations, specific diseases, and any of the inflammatory processes which increase the fibrous tissue or interfere with the normal elasticity of these valves. A stricture due to a hypertrophy of these valves is produced by the overdeveloped valves overlapping one another so as to produce a complete or partial occlusion of the lumen of the rectum.

Pressure due to adjacent organs. Pressure may be produced by a extroverted uterus, by minors of the prostate, fallopian tubes, bladder, vagina, ovaries, or the sacrum.

Acute inflammations following operations upon the uterus or its Ariadne in which a pelvic abscess burrows down into the pouch of Douglas and invades the rectal wall, sometimes produces stricture. These strictures after a very severe cellulite or a peritonitis in this region may cause from one to three strictures at different portions of the rectum or sigmoid.

Simple inflammatory stricture may follow abrasions or inflammations of the rectal mucous membrane which extend into and involve the sub mucosa A fibrous infiltration and formation of a stricture to a greater or less degree may result after an injury to the mucous membrane from either of these causes, even after the primary lesion disappears. A diffuse inflammation may exist which involves the sub mucosa This character of inflammation may extend from a blind internal fistula into the surrounding sub mucous tissue and may be so extensive as to narrow the lumen of the rectum while not involving the mucous membrane. These simple inflammatory strictures seem to depend upon the extension into the sub mucous tissue which does not involve the mucous membrane, and explains why the more superficial catarrh ulcerations seldom result in a narrowing of the lumen of the rectum.

Symptoms. The general symptoms of stricture are dependent upon the primary lesion which has resulted in this condition, also upon the form of the ulceration, the discharge of blood, pain, temperature, and the insufficient evacuation of the bowels contents. These again will vary with the location of the stricture, as strictures situated high in the rectal cavity are apt to give the symptoms of chronic constipation, with very little pain unless the result of an acute inflammation. When the stricture is situated in the anal canal the symptoms are more or less exaggerated, due to the more sensitive condition of the parts, the narrowness of the canal at this point and the involvement of the sphincters in the effort to expel the bowel contents.

As a rule, the heaviness and weight in the rectal and sacral regions produce a disturbance of the urinary apparatus. The apparent constipation becomes alarming as the difficulty in emptying the bowels increases. Ulceration and irritation, due to the distention and accumulation of the fecal matter occurs. The interference with the circulation from compression of the blood vessel produces a pressure necrosis. This often is attended with the copious discharge of thin, purulent matter and a frequent desire to defecate, resulting in straining and the passage of mucus and blood. This condition is apt to mislead one and if the diagnosis as given by the patient is accepted the trouble will be mistaken for diarrhea, as almost invariably patients presume that they are suffering from a diarrhea.

The symptoms of fecal impaction are often pronounced, although a diarrhea may exist which is made worse by the administration of opium or other drugs for its treatment. A digital examination of cases of protracted diarrhea which are associated with the feeling of fullness and heaviness in the sacral region should never be neglected. The character and amount of the discharge is largely dependent upon the nature of the stricture.

Syphilitic stricture is associated with a very abundant, dark, bloody discharge which may irritate the sphincters to such a degree as to make the condition almost unbearable. In syphilitic stricture, inflamed tags of skin with condemnatory and papillary frequently surround the anal opening.

Tubercular stricture is associated ordinarily with a creamy white discharge which is seldom mixed with blood.

The molded character of the stool in stricture does not give us any reliable symptoms of the disease and should not be considered in any sense as an indication of stricture, because as a rule, the stools are modified only by the strictures which are situated in the anal canal. Strictures which involve the sphincters infiltrate the muscle fibers and interfere with their action which gives rise to more or less incontinence.

As a result of the thinning out of the walls of the rectum or sigmoid above the narrowing of the rectal canal from a stricture we may have ulceration and rupture of the bowel which emphasizes the danger of this condition.