Few papers are available on clinical investigation of impaired defecation manifested by anal diseases probably because it is simply consideredt hat the diseases of the anus are accomp-anied with disturbed evacuation as a matter of fact. However, the data obtained from 622 questionnaires of anal patients operated in our clinic for the past 2 years revealed unexpectedly high occurrence of disturbed evacuation with the different characteristics among various anal diseases.
Preoperatively, 75% of all the patients complained of disturbed evacuation, although 75% of all the patients felt other symptoms as pain, bleeding, swelling and prolapsing more distressing than the difficulty in evacuation. As the content of impaired evacuation, following items are invariably observed in every disease, i.e., feeling of incomplete evacuation, prolonga-tion and abnormal frequency of bowel movement, thin or deformed stool and frequent use of laxatives.
The characteristics of disturbed evacuation in internal hemorrhoids (3rd degree) are; rather high incidence despite of the lacking of stenosis, feeling more affliction in other symptoms as bleeding and prolapse, low frequency of small or deformed stool, high occurrence of feeling of incomplete evacuation, abnormal frequency and prolongation of bowel movement and frequent use of laxatives.
The characteristics in fistulas are low incidence and severity, feeling other symptoms as discharge of pus more distressing, low frequency of small or deformed stool, low grade of incomplete evacuation, frequent evacuation and normal evacuation time.
The complaints of the patients suffering from concurrent hemorrhoids and fistula are severer due to the addition of both characteristics.
Fissures show high incidence and severity, frequent complaints of small and deformed stool, feeling of incomplete evacuation, constipation, prolonged evacuation time and frequent use of laxatives.
Postoperative anal stenosis, especially of Whitehead's operation brings about further severer disturbance than fissures. The cases of prolapsing of the mucosa after Whitehead's operation show almost the same pattern of complaints as hemorrhoids. The character of the impairement in rectal prolapse is singular ; the degree is low, suffering much from other symptoms asprolapsing although the feeling of incomplete evacuation and prolongation of bowel movement are remarkable.
Fistulas are divided into 6 sub-groups, each of which shows its own characteristics. The tpye I, subcutaneous fistula, shows the similar pattern of disturbance with that of fissure because most of it originates from fissure. The type II L, low intersphincteric fistula, shows lower degree of disturbance because its tract is penetrating only the external sphincters. The type II H, high intersphincteric fistula, reveals high incidence and degree of disturbance because it ascends alonfi the rectal valves into the lower rectum. The type III U, unilateral ischiorectal fistula, shows lower degree of disturbance than II L besause the lesion is unilateral. The type III B, bilateral ischiorectal fistula, shows high incidence and degree of disturbance because the lesion spreads under bilateral levators. The type III-II H, shows the severest disturbance because both bilateral levators and the lower rectum are affected.

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Leiomyomas and leiomyosarcomas may occur anywhere in the gastrointestinal tract, but those tumors of the colon and rectum are rare.
Only 8 cases of leiomyosarcoma in the colon and 30 cases of leiomyoma in the rectum have been reported in the literatures in Japan.
Recently, we have observed 2 cases of leiomyoma in the rectum and a case of leiomyosa-rcoma in the ascending colon.
These three cases were reported and we reviewed 9 cases of leiomyosarcoma in the colon and 32 cases of leiompoma in the rectum.

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Subtotal colectomy with ileo-proctostomy is followed by severe diarrhea which gradually subsides without treatment over a three to four month period. The mechanism of adaptation was studied in the dog. So morphological changes of the ileal mucosa were observed before, 1 week, 4 weeks, 12 weeks, 40 weeks following subtotal colectomy in 50 dogs. With light microscopic measurement average ileal villus length increased since 4 weeks, and the number of mucosal cells from crypt to tip of villus increased since 12 weeks. These finding shows that ileal absorptive surface increases after subtotal colectomy. Scanning electron microscope showed that ileal villi progressively changed from finger shape to tongue since 4 weeks, but ileal villi density was not changed postoperatively. Transmission electron microscope showed that the microvilli on the ileal mucosal cell did not change postoperatively, however 48 weeks after subtotal colectomy, the enteric surface coat over the microvilli developed thicker.

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