Fecal masses may be palpable per abdomen.

Perform per rectal exam to detect impacted fecal masses.

Note anatomical abnormalities such as anal stenosis, ectopic anus and anteriorly displaced anus as well as acquired lesions such as anal fissures, perianal abscess, cellulitis, and dermatitis.

Examine patient for signs of neurologic diseases, endocrine or metabolic disorders, GI diseases and Collagen vascular diseases.