Constipation is a frequent symptom in the general population. The prevalence depends on the utilized definition. We usually divide constipation in two types: obstructed defecation or prolonged bowel transit time. Obstructive defecation syndrome (ODS) has become a well-known syndrome with different clinical etiology and symptoms. If we consider ODS an “iceberg syndrome”, with “emerging rocks”, rectocele and rectal internal mucosal prolapse, that may benefit from surgery, at least two out of ten patients also has “underwater rocks” or occult disorders, such as anismus, rectal hyposensation and anxiety/depression, which mostly require conservative treatment.