It is common to see some patients, especially women, who have difficulty in defecating for a long time, and even if the stool is not dry, it is difficult to discharge, and it does not work even if they take a lot of laxatives, what is going on? This is called “outlet obstructive constipation”, is a class of diseases that has received attention in recent years. Exit obstructive constipation refers to a syndrome due to pathological changes in the tissues and organs near the bowel exit (anus), resulting in difficult defecation or detained constipation, which is characterized by difficulty in defecation, a sense of incomplete defecation, shortness of breath, and dry or non-dry stools. The common causes of outlet obstruction are: anterior rectal protrusion, endorectal stenosis, pelvic floor spasm syndrome, puborectal spasm syndrome, and retroversion of the uterus. These conditions can be suffered individually, but in most cases they are present together. Anterior rectal protrusion is most common in women and is caused by birth trauma tearing the perineal ligaments, etc. It manifests as a relaxed rectovaginal diaphragm with a pouch-like protrusion of the rectal mucosa toward the vagina. When defecating, feces can get caught in it, and patients feel that feces accumulates in the direction of the vagina and cannot be emptied, and they feel that they are dropping and have frequent bowel movements, and they need to use hand pressure or fingers to reach the vagina in front of them to defecate. If the anterior protrusion is large, the stool is repeatedly blocked and the patient is in great pain. The occurrence of intra-rectal stenosis is related to prolonged squatting and forceful defecation, causing the rectal mucosa to relax and prolapse in the rectal jugular. Since the rectal mucosa has not yet prolapsed out of the anus, it is difficult to detect, so it is easy to misdiagnose. Most patients have a long history of difficulty in defecation, and each defecation takes several hours, and pressure is applied to the perianal or vaginal area to assist defecation. Pelvic floor muscle spasm syndrome is usually triggered by a chronic lack of bowel movement and is characterized by a feeling of perineal fullness, urgency, and extreme difficulty in defecation. These patients have a history of prolonged excessive straining and painful defecation, and require finger insertion into the anus to induce defecation. Puborectal muscle spasm syndrome is related to inflammatory stimulation such as anal sinusitis, anal fissure or laxative abuse, which can lead to hypertrophy of the puborectal muscle, enlargement and narrowing of the anal canal, causing defecation difficulties. Patients feel that the anus is not relaxed even after forceful defecation, but even contracted more tightly. For the diagnosis of the above conditions, there are specific examination methods and objective diagnostic indicators, and patients can usually get a clear diagnosis at the hospital. We all know that long-term constipation can cause many diseases. For example, prolonged squatting will cause blood in the stool, hemorrhoids, anal fissures, anal fistula and other anal disorders; excessive force in defecation can sometimes cause hernias and cerebrovascular accidents in the elderly; many days without defecation can also appear mental depression, irritability, anxiety, suspicion and other symptoms of neurosis. Therefore, a positive attitude should be taken to seek medical treatment. For the treatment of constipation, the author proposes the following step-by-step treatment measures: Step 1: medication and diet therapy. Patients with constipation can initially receive oral laxative and laxative medications, such as marenza pills, laxative, fruit-conducting tablets and Chinese herbal medicine for evidence-based treatment. Sometimes the use of laxatives is ineffective, but the use of Chinese herbal medicine to tonify the qi is effective, especially in patients with qi deficiency defecation weakness is obvious. Diet more fibrous vegetables such as leek, celery and grains. These methods are not effective in the long term for outlet obstructive constipation. When ineffective, the next step or the next method can be taken at the same time. Step 2: Local medication and functional exercise. The method of fumigating sitz bath with local herbal soup in the anus (our hospital uses Fa Toxic Soup or Hemorrhoid Bath) is effective in relieving spasm, and biofeedback therapy can also be used to train defecation ability as well as self-cultivation of regular defecation habit. For example, use getting up as a signal to go to the squatting toilet after a little activity to establish a conditioned reflex. At first, you may not be used to it, but if you insist on it for 2 to 3 months, you can usually see the effect. Another example, you can exercise the diaphragm, abdominal muscles, the anal canal muscle and anal sphincter, the function of the puborectal muscle, morning in the outdoor do deep inhalation → bulging abdomen → closed to the maximum time limit → deep whistle → abdominal → closed to the maximum time limit, and then under the domination of the subjective consciousness to do anal contraction → ← relaxation activities) repeatedly for about 5 to 10 minutes. This persistence can strengthen the above muscle function, so that constipation is corrected. If it is still ineffective, surgical treatment should be actively taken. Step 3: Surgical treatment. Because outlet obstructive constipation is an objective pathological lesion, different from the functional constipation with weak conduction, so for patients with poor conservative treatment and greater pain, surgical treatment should be taken after a clear diagnosis to completely cure it. The surgical procedure can be chosen from simple to complex. Simple treatment such as submucosal injection of sclerosing agent for rectal prolapse; injection therapy can be tried first for rectal prolapse; long-acting anesthetic closure and anal dilation can be used for puborectal muscle spasm syndrome. In turn, ligation method, ligature method, posterior puborectal muscle partial severance method, anterior rectal protrusion resection suture method can be adopted. In conclusion, as long as the suitable surgical method is chosen according to the condition, satisfactory results can be achieved for this disease.