Painful Bowel Movements: Causes and Solutions

Experiencing pain during bowel movements?

Hello Doctor, I have been experiencing constipation and bloating for several years.
Since last year, I often feel sharp pain during bowel movements, and sometimes my stools are very hard.
After using the restroom, I still feel pain around the anus.
Recently, I have noticed that my stools are sometimes in small, connected pieces, and occasionally there is bright red blood on the toilet paper after wiping.
I frequently feel the urge to have a bowel movement near the anus, but I am unable to pass stool, and sometimes it feels like my bowel movements are incomplete.
I previously consulted a gastroenterologist who diagnosed me with irritable bowel syndrome.
Since last year, I have started eating more vegetables (I used to be a picky eater and rarely consumed them) and have been incorporating high-fiber foods into my diet.
Do I need to undergo any tests, or can I just see a doctor for medication? (Due to restrictions related to pneumonia, hospitals are currently regulated, so I thought I would inquire online first.) Thank you for your hard work during this time.

Niming, 20~29 year old female. Ask Date: 2020/03/20

Dr. Ke Fangxu reply Surgery

At the age of 23, the likelihood of developing colorectal cancer is not zero, but generally speaking, it is extremely low.
Based on your description, it seems more like hemorrhoidal bleeding.
It is recommended to maintain a light diet and good lifestyle habits, while avoiding spicy, irritating, and greasy foods.
Increasing dietary fiber intake can also be beneficial.
If symptoms persist without improvement, you may consult a physician for medication or consider undergoing a colonoscopy.

Reply Date: 2020/03/20

More Info

Understanding painful bowel movements can be quite complex, as there are numerous factors that can contribute to discomfort during defecation. Based on your description, it seems you are experiencing a combination of constipation, abdominal bloating, and painful bowel movements, which may be indicative of several underlying issues.

Firstly, the symptoms you describe—hard stools, pain during bowel movements, and the presence of blood on toilet paper—are concerning and warrant further investigation. The blood you notice could be due to several reasons, including hemorrhoids, anal fissures, or even more serious conditions like diverticular disease or inflammatory bowel disease (IBD). Hemorrhoids are swollen veins in the lower rectum and anus that can cause pain and bleeding, especially during bowel movements. Anal fissures, which are small tears in the lining of the anus, can also lead to sharp pain and bleeding when passing hard stools.

The fact that you have been experiencing constipation for several years and have recently started eating more vegetables and high-fiber foods is a positive step towards improving your bowel health. However, if your diet has changed and you are still experiencing these symptoms, it may be necessary to evaluate other factors that could be contributing to your condition. For instance, inadequate fluid intake can lead to hard stools, and certain medications or medical conditions can also affect bowel regularity.

Additionally, your mention of feeling a constant urge to defecate without being able to do so could suggest a condition known as "rectal tenesmus," which is a feeling of incomplete evacuation. This can be associated with conditions like irritable bowel syndrome (IBS), which you mentioned was previously diagnosed. IBS is a functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits, including constipation and diarrhea. Stress and anxiety can exacerbate IBS symptoms, so it's essential to consider your mental health as well.

In terms of management, it is crucial to maintain a well-balanced diet rich in fiber, but it is equally important to ensure adequate hydration. Drinking plenty of water can help soften stools and make them easier to pass. Over-the-counter stool softeners or laxatives may provide temporary relief, but they should be used cautiously and not relied upon long-term without consulting a healthcare provider.

Given the presence of blood and the severity of your symptoms, I strongly recommend seeking medical attention. A healthcare professional may suggest diagnostic tests such as a colonoscopy or flexible sigmoidoscopy to rule out any serious conditions. They may also evaluate your bowel habits, dietary intake, and lifestyle factors to develop a comprehensive treatment plan tailored to your needs.

In summary, while dietary changes are beneficial, the persistence of your symptoms, especially the presence of blood, necessitates a thorough evaluation by a healthcare provider. They can help determine the underlying cause of your painful bowel movements and develop an appropriate treatment strategy to alleviate your discomfort and improve your overall bowel health. Remember, early intervention can lead to better outcomes, so don't hesitate to reach out for help.

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