Constipation: Symptoms, Causes, and When to Seek Help

Bowel issues

Hello, doctor.
I have some questions.
I have a habit of constipation and usually rely on drinking milk to help me have bowel movements (I am lactose intolerant).
Sometimes after drinking milk, I need to go to the bathroom (the stool is normal), but other times it's every three days.
In early January, I took fruit enzymes to help with regular bowel movements.
On the first day after taking them, my stool was normal, but at other times, it has been thin.
If I don't drink milk, I don't feel the urge to have a bowel movement.
Currently, my stool is still thin.
Today, I noticed that the beginning and end of the stool were slightly normal, while the middle part was thin.
Previously, I would notice blood when wiping after a bowel movement (only when the stool was very hard), but now there is no blood when I wipe.
Occasionally, I feel a stabbing pain and dull ache in the left lower abdomen, and sometimes slight pain in the left upper abdomen or near the belly button (I recently started going to the gym).
I'm unsure if this pain is from muscle strain due to exercise or from a medical condition (the pain varies, mostly stabbing and dull, but not severe).
Occasionally, I also feel nauseous (like I want to vomit after eating too much, but I don't actually vomit).
About six to eight months ago, I had a colonoscopy, which was normal and did not reveal any polyps.
At that time, I only had abdominal pain (stabbing and dull) and irregular bowel movements.
I asked the doctor why I was experiencing slight abdominal pain, and the doctor suggested it might just be indigestion and advised me to drink more yogurt.
I would like to ask if this could be considered irritable bowel syndrome or if there is a possibility of cancer?

Le, 20~29 year old female. Ask Date: 2017/01/14

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Based on the symptoms, it appears to be functional gastrointestinal disorder.
It is recommended to increase the intake of fruits and vegetables, drink plenty of water, maintain adequate physical activity, and perform abdominal massage during bowel movements.
Additionally, adjustments may require the use of gastrointestinal medications.

Reply Date: 2017/01/14

More Info

Constipation is a common gastrointestinal issue that can significantly affect one's quality of life. It is characterized by infrequent bowel movements, difficulty passing stools, or a sensation of incomplete evacuation. Understanding the symptoms, causes, and when to seek help is crucial for managing this condition effectively.

Symptoms of Constipation
The symptoms of constipation can vary from person to person, but they typically include:
1. Infrequent Bowel Movements: Having fewer than three bowel movements per week is often considered a sign of constipation.

2. Difficulty Passing Stools: Straining during bowel movements or feeling as though you cannot completely empty your bowels.

3. Hard or Lumpy Stools: Stools that are hard, dry, or lumpy can indicate constipation.

4. Abdominal Discomfort: This can include bloating, cramping, or pain in the abdomen, which may be intermittent or persistent.

5. Rectal Discomfort: Pain or discomfort during bowel movements, which can sometimes lead to bleeding if excessive straining occurs.

Causes of Constipation
Constipation can be caused by a variety of factors, including:
1. Dietary Factors: A diet low in fiber, inadequate fluid intake, or excessive consumption of dairy products can contribute to constipation.

2. Lifestyle Factors: Lack of physical activity, ignoring the urge to have a bowel movement, or changes in routine can lead to constipation.

3. Medical Conditions: Conditions such as irritable bowel syndrome (IBS), hypothyroidism, diabetes, and neurological disorders can affect bowel function.

4. Medications: Certain medications, including opioids, antacids containing aluminum, and some antidepressants, can cause constipation as a side effect.

When to Seek Help
It is essential to seek medical attention if you experience any of the following:
1. Severe or Persistent Symptoms: If constipation lasts for more than three weeks or is accompanied by severe abdominal pain, it is important to consult a healthcare provider.

2. Blood in Stool: Any presence of blood in the stool, especially if it is associated with pain, should be evaluated by a doctor.

3. Unexplained Weight Loss: If you experience significant weight loss without trying, this could indicate a more serious underlying condition.

4. Change in Bowel Habits: A sudden change in bowel habits, especially in older adults, should be assessed to rule out serious conditions such as colorectal cancer.

Your Situation
Based on your description, it seems you have been experiencing chronic constipation, which is exacerbated by your lactose intolerance and reliance on milk for bowel movements. The presence of blood in your stool during straining, although it has improved, is still a concern. The varying consistency of your stools, along with abdominal pain and discomfort, could suggest a functional gastrointestinal disorder such as irritable bowel syndrome (IBS), but it is essential to rule out other conditions.

The fact that you had a colonoscopy that returned normal results is reassuring, but it does not completely eliminate the possibility of other gastrointestinal issues. The intermittent abdominal pain you are experiencing could be related to muscle strain from exercise or could be a symptom of IBS or another functional disorder.

Recommendations
1. Dietary Adjustments: Increase your fiber intake through fruits, vegetables, whole grains, and legumes. This can help improve stool consistency and frequency.

2. Hydration: Ensure you are drinking enough fluids, as dehydration can worsen constipation.

3. Regular Exercise: Engage in regular physical activity, as this can help stimulate bowel function.

4. Consult a Gastroenterologist: Given your symptoms and history, it would be wise to consult a gastroenterologist for further evaluation. They may recommend additional tests or treatments tailored to your specific condition.

5. Keep a Symptom Diary: Documenting your symptoms, dietary habits, and bowel movements can provide valuable information to your healthcare provider.

In conclusion, while your symptoms may suggest a functional gastrointestinal disorder, it is crucial to seek professional medical advice to rule out any serious conditions and to develop an effective management plan.

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