There are many reasons why the stool can’t be pulled out at the anal opening, the common reasons are as follows: first, if there is anal stenosis, such as previous hemorrhoidectomy or other surgery around the anus, it will lead to scar formation around the anus, resulting in anorectal stenosis, which will obstruct the fecal discharge when defecating, thus leading to the stool can’t be pulled out at the anal opening, rectal examination can be performed to clarify the diagnosis. Second, if there is exit obstruction type of constipation, such as puborectal hypertrophy, puborectal muscle spasm, anal canal internal sphincter spasm, rectal intussusception, rectal protrusion, small intestine and sigmoid hernia will lead to difficulty in defecation, stool blocked in the anal opening can not be pulled out. In this case, a rectal examination and, if necessary, a fecal imaging can be performed to clarify the diagnosis.