Constipation: Causes, Symptoms, and Solutions - Gastroenterology and Hepatology

Constipation

Hello Doctor: Two months ago, I experienced rectal bleeding during a bowel movement.
Although it was just once, the amount of blood was significant, so I visited a colorectal specialist that same day.
The doctor performed a digital examination and found internal hemorrhoids.
After treatment, my bowel movements returned to normal.
However, in the past week, I have been feeling a sensation of incomplete evacuation during bowel movements.
The stools I pass are soft, small, and droplet-like, and the quantity is very minimal.
I have also been passing gas frequently, which has a strong odor.
During my first visit to the doctor, I was prescribed a stool softener, and I took six capsules that day.
The next morning, I had one episode of diarrhea, so I stopped taking the medication.
However, the following morning, I still had another bowel movement, and the stools were very thin and long.
During my second visit, the doctor again found internal hemorrhoids, but they were not large, so no further treatment was provided, and I was advised to improve my diet.
Despite eating a lot of vegetables, dragon fruit, and bananas, and drinking plenty of water, my condition has not improved.
I would like to ask the doctor if the sensation of blockage during bowel movements, with only a small amount of droplet-like stools and no bleeding, could indicate that something is pressing on the colon.
What further measures can I take to improve this situation? What other conditions could cause these symptoms? Do I need any further examinations? There is no family history of colorectal cancer in my household; is it possible that I have colorectal cancer? Thank you for your assistance.

Z, 10~19 year old female. Ask Date: 2019/02/02

Dr. Chen Qifeng reply Gastroenterology and Hepatology

The likelihood of colorectal cancer is low; please prioritize following your physician's recommendations and prescriptions.
If there is still no improvement, then consider further examinations.

Reply Date: 2019/02/02

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 stool, or a sensation of incomplete evacuation. Understanding the causes, symptoms, and potential solutions for constipation is crucial for effective management.

Causes of Constipation
1. Dietary Factors: A diet low in fiber can lead to constipation. Fiber is essential for adding bulk to the stool and facilitating its passage through the intestines. Foods rich in fiber include fruits, vegetables, whole grains, and legumes.

2. Dehydration: Insufficient fluid intake can result in hard, dry stools that are difficult to pass. It is important to drink adequate amounts of water throughout the day.

3. Physical Inactivity: A sedentary lifestyle can slow down the digestive system. Regular physical activity helps stimulate intestinal function.

4. Medications: Certain medications, including opioids, antacids containing aluminum, and some antidepressants, can contribute to constipation.

5. Medical Conditions: Conditions such as hypothyroidism, diabetes, and neurological disorders can affect bowel function. Additionally, structural issues in the colon, such as strictures or tumors, can lead to obstruction and constipation.

6. Psychological Factors: Stress, anxiety, and depression can also impact bowel habits. The gut-brain connection plays a significant role in gastrointestinal health.

Symptoms of Constipation
Common symptoms include:
- Infrequent bowel movements (fewer than three times a week)
- Straining during bowel movements
- Hard or lumpy stools
- A feeling of blockage or obstruction in the rectum
- Abdominal discomfort or bloating
In your case, the sensation of incomplete evacuation and the presence of small, soft stools may indicate a functional issue rather than a structural one. The fact that you experienced rectal bleeding previously could be related to hemorrhoids, which can cause discomfort and alter bowel habits.

Solutions and Management
1. Dietary Changes: Continue to increase your fiber intake through fruits, vegetables, whole grains, and legumes. Foods like prunes and psyllium husk are particularly effective for promoting regular bowel movements.

2. Hydration: Ensure you are drinking enough water daily. Aim for at least 8-10 cups, adjusting based on your activity level and climate.

3. Physical Activity: Incorporate regular exercise into your routine. Even moderate activities like walking can stimulate bowel function.

4. Over-the-Counter Remedies: If dietary changes are insufficient, consider using over-the-counter laxatives or stool softeners. However, use these sparingly and consult with a healthcare provider before starting any new medication.

5. Routine: Establish a regular bowel routine by setting aside time each day to attempt a bowel movement, ideally after meals when the digestive system is most active.

6. Stress Management: Engage in stress-reducing activities such as yoga, meditation, or deep-breathing exercises, as stress can exacerbate gastrointestinal issues.

When to Seek Further Evaluation
Given your symptoms and history, it is essential to monitor your condition. If you experience any of the following, seek medical attention promptly:
- Persistent changes in bowel habits
- Severe abdominal pain
- Unexplained weight loss
- Blood in the stool
- Symptoms that do not improve with dietary and lifestyle changes
While you mentioned a family history of colorectal cancer is absent, it is still important to consider that any significant change in bowel habits warrants further investigation. Your healthcare provider may recommend additional tests, such as a colonoscopy, to rule out any underlying conditions, especially if symptoms persist or worsen.

In conclusion, constipation can often be managed effectively through dietary and lifestyle modifications. However, if symptoms continue or if there are any concerning signs, further evaluation by a healthcare professional is essential to ensure proper diagnosis and treatment.

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