How to Effectively Manage Chronic Constipation and Digestive Issues

"Constipation Issues: How to Improve Bowel Movement Problems"

Hello Doctor: I have been experiencing long-term constipation issues, having a bowel movement every two to three days, or sometimes even longer.
Occasionally, I also have diarrhea, and during bowel movements, I feel a tearing sensation in my anus, sometimes accompanied by slight bleeding.
I tend to have easier bowel movements before my menstrual period.
Two months ago, I finally decided to see a gastroenterologist due to my distress.
The doctor prescribed Magnesium and advised me to take one tablet after each meal.
I didn't take it regularly for the first month (mainly because I noticed a significant weight gain after taking it for a week, which stopped once I discontinued the medication).
However, I followed the dietary recommendations from the doctor: drinking 500cc of warm water every morning, eating bananas before breakfast and lunch, and ensuring I consume over 300g of vegetables daily.
With this dietary regimen, as long as I didn't neglect water and bananas, I was able to have daily bowel movements.
By the beginning of the second month, I had almost stopped taking the medication and maintained daily bowel movements for about two weeks, without experiencing anal pain or bleeding during bowel movements.
On the 9th, I was busy and had no urge to go, but on the 10th, I returned to normal.
Unfortunately, I might have eaten something bad, and on the 15th, I had no bowel movement and started passing very foul gas.
On the 16th, I went to the bathroom twice; the first time, the stool was very hard and larger than usual, while the second was somewhat loose but not watery, more like formed strips, accompanied by anal pain and bleeding.
The second bowel movement was thinner and also loose, with both being a clay-yellow color.
Since that day, I have started experiencing occasional mild abdominal pain (mild enough that I thought it was just muscle strain from abdominal movements, but later realized the pain shifts around to different areas: lower right, mid-lower, and left side).
I also frequently pass gas, which had a slight odor on the 17th and 18th, but was much milder compared to the 15th and 16th.
On the 18th, despite having little urge to go, I forced myself to sit on the toilet and only managed to pass about 1/3 to 1/2 of a normal amount, and it wasn't formed, with a slightly darker color.
Today, the 19th, I have no urge to go at all, but the gas I am passing is nearly odorless.
I would like to ask the doctor, as I was experiencing this recurring situation before I visited the gastroenterologist, and the doctor did not clearly inform me of what condition I have or what might be causing it.
Should I continue with the dietary approach, which seems to be improving my situation, or should I return to taking the Magnesium prescribed by the doctor? Thank you for your patience in reading this.

Xiao Ting, 20~29 year old female. Ask Date: 2016/11/19

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, constipation is a common issue among women, often related to poor gastrointestinal motility and can also be influenced by menstrual flow.
It is recommended to use stool softeners and increase your intake of fruits, vegetables, and fiber, along with drinking plenty of water and exercising.
Additionally, it is important to collaborate with a gastroenterologist for treatment.
Stool softeners will not cause weight gain, so there is no need to worry.
Changhua Hospital cares about your health.
Chen Shidian

Reply Date: 2016/11/19

More Info

Managing chronic constipation and digestive issues can be a complex process, especially when symptoms fluctuate and vary in severity. Based on your description, it seems you have made significant progress with dietary changes and have experienced some relief from constipation. However, the recurrence of symptoms such as abdominal pain, rectal bleeding, and changes in stool consistency indicates that further evaluation and management may be necessary.

Understanding Your Symptoms
Chronic constipation can be caused by a variety of factors, including dietary habits, hydration levels, physical activity, and underlying medical conditions. The fact that you experience pain and bleeding during bowel movements suggests that there may be additional issues at play, such as anal fissures or hemorrhoids, which can develop as a result of straining during defecation. The presence of blood in your stool, even if minor, should be taken seriously, and it is advisable to follow up with your healthcare provider to rule out any serious conditions.

Dietary Management
1. Hydration: It is essential to maintain adequate hydration, as water helps soften stool and promotes regular bowel movements. You mentioned drinking warm water in the morning, which is a good practice. Aim for at least 8-10 cups of water daily, adjusting based on your activity level and climate.

2. Fiber Intake: Increasing dietary fiber is crucial for managing constipation. You mentioned consuming over 300 grams of vegetables daily, which is excellent. Additionally, incorporating whole grains, legumes, nuts, and seeds can further enhance fiber intake. Aim for a total daily fiber intake of 25-30 grams.

3. Fruits: Bananas are a good source of fiber, but consider adding other fruits such as apples, pears, berries, and prunes, which are known for their natural laxative effects.

4. Regular Meals: Eating regular meals can help stimulate bowel activity. Try to maintain a consistent eating schedule, as this can help regulate your digestive system.

Medication Considerations
While magnesium supplements can help with constipation, it is important to use them under the guidance of a healthcare professional. If you find that your symptoms improve with dietary changes but worsen when you stop taking magnesium, it may be worth discussing with your doctor whether to continue or adjust the dosage.

Monitoring Symptoms
Keep a symptom diary to track your bowel movements, dietary intake, and any associated symptoms. This information can be invaluable for your healthcare provider in determining the best course of action. Note any patterns, such as changes in bowel habits around your menstrual cycle, which you mentioned can affect your bowel movements.

When to Seek Further Help
If your symptoms persist or worsen, or if you experience significant abdominal pain, changes in bowel habits, or any new symptoms, it is crucial to seek further evaluation from a gastroenterologist. They may recommend additional tests, such as imaging studies or a colonoscopy, to rule out any underlying conditions.

Conclusion
In summary, continue with your dietary modifications, maintain hydration, and monitor your symptoms closely. If you experience any concerning changes, do not hesitate to reach out to your healthcare provider for further evaluation. Managing chronic constipation often requires a multifaceted approach, and with the right strategies, you can work towards achieving more consistent and comfortable bowel movements. Remember, it’s important to be patient with yourself as you navigate these changes, and don’t hesitate to seek support from healthcare professionals when needed.

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