1, constipation: The initial application of fecal imaging technology was to diagnose patients with constipation and dyspareunia. With the development of technology, medical diagnostic equipment, such as anal manometry, electromyography or colonic transmission tests, have a very important role in identifying the cause. Therefore, although the vast majority of indications for fecal imaging remain constipation, patients with other symptoms can sometimes be examined with fecal imaging. The following are indications for patients who underwent consecutive fecal imaging at the Minnesota Pelvic Floor Disease Center over a 12-month period (study results): Fecal imaging indications (n=954) % Constipation 33 Suspected small bowel hernia or rectal prolapse 11.3 Incontinence 6.3 Rectal condyloma or prolapse 11.3 Fecal incontinence 31.3 Painful stool 3.7 Urinary incontinence or uterovaginal prolapse 2.5 Postoperative evaluation 0.6 2, Suspected small bowel hernia or prolapsed rectum: The main symptom of small bowel hernia or prolapsed rectum is the need for prolonged straining during defecation and the sensation of partial or complete filling. Patients feel that there is a “piston” blockage in the anus during defecation. Fecal imaging can confirm the presence of rectal prolapse and small bowel hernia, suggest the presence of peritoneal protrusion, and have definite diagnostic significance for certain conditions such as pelvic floor contracture, endorectal intussusception, or rectal prolapse. It can also indicate whether there is potential uterovaginal prolapse. 3, incomplete defecation: incomplete defecation refers to the feeling that stool remains in the rectum after defecation, often accompanied by immediate defecation again or finger-assisted defecation. The incomplete defecation is closely related to the obstruction of defecation and is usually caused by endorectal intussusception, rectal prolapse or small bowel hernia. 4, endorectal intussusception and rectal prolapse: without fecal imaging, endorectal intussusception or rectal prolapse is very difficult to diagnose. With the occurrence of endorectal intussusception there will be obvious rectal prolapse, the patient’s performance will have rectal bleeding and a feeling of fullness. Rectal finger examination can reveal decreased rectal and anal sphincter tone, and proctoscopy can confirm associated states such as mucosal erythema or isolated rectal ulcers. These manifestations are due to local ischemia caused by protrusion and compression of the intestinal wall into the rectal lumen. 5, fecal incontinence: The usefulness of fecal imaging in patients with fecal incontinence is limited and may be helpful for fecal incontinence with symptoms of fecal obstruction. Fecal imaging can be helpful in the diagnosis of patients with superfluid fecal incontinence and can confirm whether their fecal retention is associated with puborectal muscle spasm or fecal retention in the giant rectal protrusion. 6, painful defecation: painful defecation of unknown origin or a feeling of urgency is usually difficult to diagnose and even more difficult to treat. In addition to the obvious causes of this symptom, such as anal fissures, hemorrhoids, ulcers, etc., anatomical factors should be excluded from causing pain. For example, paradoxical contraction of the pelvic floor muscles may lead to anal contracture or spasmodic pain, and severe peritoneal descent may also lead to pulling of the external pubic nerves, which can cause vague pain after defecation. 7. Urinary incontinence and utero-vaginal prolapse: Up to 41% of patients with urologic and obstetric-gynecological disorders caused by pelvic floor disorders are also associated with fecal incontinence. It is recommended that the function of the pelvic floor muscles should be thoroughly evaluated before major surgery and that repair of rectal prolapse will not correct pre-existing incontinence that is not yet clinically evident. Obviously, careful history taking and thorough examination are important in patients with both genitourinary and rectal disorders and should be performed prior to surgical procedures. 8. Postoperative evaluation: A very important examination item in postoperative follow-up is defecography. Patients with a history of defecation difficulties after ileal pouch-rectal anastomosis may be due to poor stool control, pouch contracture, anastomotic stricture, or other causes of obstruction. For the evaluation of sudden onset of defecation difficulties after sphincteroplasty, prolapse repair, or colectomy, a defecography can be helpful. Defecography is also useful to evaluate symptoms of incontinence that do not improve after repair or to determine stool self-control before closure of the fistula.