1.Specialized examination (1)Visual diagnosis Visual diagnosis may have no positive signs, or may be accompanied by external hemorrhoids and other symptoms of anal diseases. (2) Rectal palpation Patients with rectal proptosis can touch the weak area of the anterior rectal wall that is rounded and protrudes towards the vagina during rectal palpation, which is more obvious when straining to defecate, and the tip of the finger can feel that the intestinal wall tension is reduced, and the intestinal wall recovers slowly or fails to recover at the end of the palpation. In patients with internal rectal mucosal prolapse, the patient takes the squatting position or the lateral lying position and performs the defecation maneuver, the mucosa in the rectal lumen can be palpated as folded and piled up, soft and smooth, moving up and down, with a sense of congestion, and there is a ring-shaped groove between the internal prolapsed part and the bowel wall. In patients with combined perineal descent syndrome, anal canal dilatation at rest is diminished, and when the patient is instructed to perform casual contractions, anal canal contraction is markedly diminished. Patients with combined pelvic floor dystocia syndrome have high anal canal tone and require force to pass through the anal canal. The anal canal was long, and the puborectalis muscle was hypertrophied and spastic. When simulating defecation, the anal canal contracts instead of relaxing, which is often referred to as “paradoxical contraction”. (3) sigmoidoscopy or anorectoscopy, such as the combination of rectal mucosal prolapse and perineal descent syndrome patients with a little abdominal pressure that is visible in the rectal submucosal accumulation, like a cork-like protrusion into the opening of the lens tube. In the rectal-anal junction, there is a ring or cervix-like mucosal fold. Proctoscope can see too much rectal mucosa, can be seen embedded in the mirror cavity or appear in the teeth line below, the patient can see mucosal edema, brittle, congestion, or ulcers, polyps and other lesions. 2.Colon transmission test A test to determine the function of the colon. Subjects are forbidden to take laxatives and other drugs that affect intestinal function since 3 days before the test. On the day of the examination, 20 capsules of opaque markers are taken for breakfast, and then 1 flat film of the abdomen is taken every 24 hours until more than 80% of the markers are discharged. The maximum number of abdominal films should not exceed 5, and the number of films should be reduced in unmarried women. Mixed constipation patients with less than 80% of markers discharged within 72 hours is normal, and abdominal plain film shows that there are markers retained in the colon and rectum. 3, fecal imaging fecal imaging is injected into the patient’s rectum through the contrast agent, “defecation” when the anorectal part of the anogenital tube, static observation of the combination of inspection methods. Mixed constipation patients with positive fecography. 4.Balloon forced out test is a relatively simple test method to determine whether the constipation belongs to the outlet obstruction. First of all, the balloon is placed in the subject’s rectal potbelly, injected with warm water (39 ℃) 50 ml, and then let the subject take the habitual defecation posture (sitting or squatting), and instructed to discharge the balloon as soon as possible. Patients with mixed constipation could not expel the balloon within 5 minutes. 5, anorectal pressure measurement Through the anorectal manometry, the determination of anal tube resting pressure, maximum squeeze pressure, rectal perception threshold, rectal maximum tolerance and other indicators, you can understand the change of anorectal pressure during defecation. Mixed constipation patients have contradictory contraction of the external anal sphincter during forceful defecation. Pelvic floor electromyography (PFEM) can be used to determine the neuromuscular function and morphology by recording the neuromuscular bioelectric activity. In patients with mixed constipation, dysfunctional electrical activity is obvious during defecation maneuvers, and there is paradoxical contraction of puborectalis muscle during forceful defecation, which hinders the discharge of feces. In combined puborectal muscle hypertrophy, muscle activity was diminished during casual contractions and voltage decreased, indicating myogenic damage.