In this condition as a rule there are at first merely symptoms of constipation; later on these become more obstinate, requiring stronger cathartics. The patient now begins to complain of congestion of the head, anorexia, nausea, cold feet, and sometimes of disagreeable sensations in his limbs; still later there is diarrhoea which may persist as such or alternate with constipation. Off and on muco-purulent material appears with the dejecta. A burning sensation is often felt in the rectum, and tenesmus is frequently present. Hemorrhoids and prolapse of the rectum often accompany the stricture.

Digital examination of the rectum often reveals a ste-nosed area in its lower part. The finger is either not able to pass any farther than a few centimetres (five to six) above the anus or it meets with a resistance which it can overcome. Contrary to spasm of the rectum which yields completely after the finger has succeeded in passing the constriction, in stricture of the rectum the pressure of the narrowed lumen exerted upon the finger remains constantly the same.

Most of the strictures are situated about five to six centimetres above the anus, seldom higher up. In the latter instance the examination must be made with a bougie or with a rubber tube which is not too soft. In order to determine the exact nature of the stricture it is always best to make a visual examination of the rectum by means of a speculum.

Complications

No matter to what cause the intestinal obstruction is due, in the protracted course of the disease several complications are liable to occur, although here less often than in acute obstruction. Above the stenosed area ulcerations of the bowel may take place and perforation may occur, giving rise to general peritonitis. Occasionally circumscribed peritonitis may ensue in a similar manner and lead to an abscess surrounded by adhesions. Such an abscess may rupture through the abdominal wall and under favorable conditions (if communicating with the intestinal lumen) form a fecal fistula. In many instances the patients gradually waste away and die in con sequence of thrombosis of the crural vein and decubitus.