“…In our experience, most of these patients also have some disorder of the cardiovascular system. According to recent reports (7, 8), straining at stool, when associated with constipation, can have very serious or even fatal sequelae in patients with cardiovascular lesions, and may also induce ventral, femoral or inguinal hernia (2). In addition, failure to empty the rectum may result in fecal impaction which, in turn, may lead to a variety of other symptoms such as rectal pain, tenesmus, abdominal cramps and general discomfort.…”