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©2013 UpToDate ® Print Email Nineteen-year-old woman with life-long history of severe constipation A) In this 19 year-old woman with a life-long history of constipation, the anus is clearly anteriorly located, with a short perineal body. Normally, the anus should be located in the shiny pigmented skin, which is posterior to anal opening in this patient. B) Barium enema in the same patient. There is marked dilatation of rectum, extending to the anus. This is the typical appearance of so-called "habit constipation" or "psychogenic" constipation. However, some of these cases are probably caused by unrecognized slight anorectal malformation, as in this case. After anoplasty, this patient developed normal defecation patterns. Reproduced with permission from: Hendren WH. Pediatric rectal and perineal problems. Pediatr Clin North Am 1998; 45:1353. Copyright ©1998 Elsevier.