Constipation and Hemorrhoids: Causes and Solutions - Gastroenterology and Hepatology

Constipation and difficulty in bowel movements can lead to severe hemorrhoids?

About three months ago, my stool suddenly changed to a pellet-like consistency, resembling sheep feces, with individual pieces varying in size, all sinking to the bottom of the toilet without floating.
However, I do not experience any difficulty in passing stool.
A month ago, my family doctor tested for occult blood in my stool, which was negative, and arranged for a colonoscopy.
However, I suddenly developed a small lump on my anus that cannot be pushed back in (previously, I had occasional lumps that could be pushed back).
After an urgent visit to a colorectal specialist, I was prescribed a topical ointment and a stool softener.
The doctor advised against performing the colonoscopy for fear of rupturing the hemorrhoid.
On the third day of medication, I had a beautiful, long, soft stool, but on the fourth day, it became thin and elongated, and then reverted back to pellet-like stool.
The hemorrhoid protrudes every time I have a bowel movement, but I can push it back in with my finger after applying the ointment.
However, I am now experiencing difficulty in passing stool.
I have daily bowel movements, often twice a day, and I observe the stool produced; the amount is occasionally small (1-4 pieces the size of peanuts) but mostly of moderate size (initially 1-3 pieces the size of grapes, followed by a compressed mass resembling a bunch of small pellets, about the thickness of a banana and approximately 5 centimeters long).
The color is normal yellow, with no foul odor.

I would like to ask: 1.
Is it possible that there are polyps in my intestine causing difficulty in passing stool at certain points, leading to rapid water absorption and resulting in the pellet-like formation? This stool consistency is quite bothersome.
2.
Given the presence of external hemorrhoids, is it advisable to proceed with the colonoscopy? (Or is it absolutely necessary?) I am very concerned about the risk of the external hemorrhoid rupturing or perforating the intestine (the procedure is planned under general anesthesia, and I may not be able to respond to the doctor regarding whether they have reached the bend in the intestine).

KT, 40~49 year old female. Ask Date: 2018/09/17

Dr. Chen Qifeng reply Gastroenterology and Hepatology

In general, polyps are not large enough to obstruct the passage of stool.
Bowel issues are primarily due to functional disorders.
It is advisable to treat hemorrhoids first, and then proceed with a colonoscopy afterward.

Reply Date: 2018/09/17

More Info

Understanding constipation and hemorrhoids is crucial for addressing the discomfort and complications associated with these conditions. Based on your description, it appears you are experiencing a combination of symptoms that may be linked to both constipation and hemorrhoids.

1. Possible Causes of Your Symptoms
The formation of hard, pellet-like stools (often referred to as "sheep feces") can be attributed to several factors, primarily related to dietary habits, hydration levels, and bowel function. When stools are small and hard, it often indicates that they have been in the colon for an extended period, leading to excessive water absorption. This can be exacerbated by a low-fiber diet, inadequate fluid intake, and a sedentary lifestyle.

In your case, the presence of a "meatball" or external hemorrhoid that cannot be pushed back in suggests that you may be dealing with a thrombosed hemorrhoid, which can occur when there is increased pressure in the rectal area, often due to straining during bowel movements. This pressure can lead to the formation of hemorrhoids, which can become painful and swollen.

2. The Role of Polyps
Regarding your concern about the possibility of intestinal polyps causing your symptoms, it is indeed possible for polyps to obstruct the passage of stool, leading to changes in stool consistency. However, the presence of small, hard stools alone does not definitively indicate the presence of polyps. The negative fecal occult blood test is a reassuring sign, as it suggests that there is no significant bleeding from the gastrointestinal tract, which is often associated with polyps or malignancies.

3. The Need for a Colonoscopy
As for whether you should proceed with a colonoscopy, it is essential to weigh the risks and benefits. A colonoscopy is a valuable diagnostic tool that can help identify any abnormalities in the colon, including polyps, diverticula, or other issues. Given your symptoms and the recent development of hemorrhoids, it may be prudent to discuss the necessity of the procedure with your healthcare provider.

Your concerns about the potential for the hemorrhoid to rupture or for the colon to be perforated during the procedure are valid. However, a skilled gastroenterologist will take precautions to minimize these risks. If the hemorrhoid is causing significant discomfort or if there are concerns about the potential for complications, your doctor may recommend treating the hemorrhoid first before proceeding with the colonoscopy.

4. Management Strategies
In the meantime, there are several strategies you can implement to alleviate your symptoms:
- Dietary Changes: Increase your fiber intake by consuming more fruits, vegetables, whole grains, and legumes. This can help soften the stool and promote regular bowel movements.

- Hydration: Ensure you are drinking adequate fluids throughout the day, as this can help prevent dehydration and promote softer stools.

- Physical Activity: Engage in regular physical activity, as this can stimulate bowel function and help prevent constipation.

- Medications: Continue using the stool softeners and topical treatments as prescribed by your doctor. If you find that your current regimen is not effective, discuss alternative options with your healthcare provider.

Conclusion
In summary, your symptoms may be indicative of constipation and hemorrhoids, potentially complicated by the presence of polyps. While a colonoscopy may be necessary for further evaluation, it is essential to discuss your concerns with your healthcare provider to determine the best course of action. Implementing dietary and lifestyle changes can also significantly improve your bowel health and alleviate discomfort. Always consult with your healthcare provider before making any changes to your treatment plan.

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