Rectal Discomfort: Causes of Incomplete Cleaning After Bowel Movements

Discharge and difficulty cleaning after bowel movements?

Hello Dr.
Ke, I would like to ask about a situation I have been experiencing.
Approximately nine months ago, I visited the colorectal surgery department at Tainan Hsin-Lou Hospital.
At that time, I did not mention that I had difficulty cleaning myself after bowel movements; I only reported having some discharge.
The doctor performed a simple digital examination and informed me that my anal area was healthy.
I was frequently cleaning or washing my anal area, and the doctor advised me that I was too clean and washing too often, which could lead to issues like fistulas.
Some people’s anal areas are better off being a bit dirty rather than overly clean.
The doctor recommended that I refrain from washing my anal area for a week and just use a single piece of toilet paper to gently wipe after bowel movements.
As it was approaching winter, I felt somewhat better at that time.
Recently, after using body wash to clean myself post-bowel movement, I still notice a bit of fecal matter mixed with some discharge after a few hours, even after wiping with toilet paper.
I experience mild constipation, having bowel movements approximately every two days.
If I do not have a bowel movement on a given day, I occasionally notice yellowish-white discharge that has a somewhat fishy odor, which tends to cling to my underwear, especially noticeable in the summer when I sweat.
Could you please help me understand what this issue might be? I had a colonoscopy at the same hospital three years ago, and there were no reported issues at that time.

Sanguo, 30~39 year old female. Ask Date: 2020/06/27

Dr. Ke Fangxu reply Surgery

The anal area is not a sterile environment, and excessive cleaning can lead to certain skin complications.
Common issues include skin inflammation or itching.
Some individuals even wash inside the anus, which can result in rectal inflammation and increased secretions.
It is recommended to simply wash with clean water on a daily basis.
This may also help improve constipation issues.

Reply Date: 2020/06/27

More Info

Understanding rectal discomfort and the challenges associated with incomplete cleaning after bowel movements can be quite complex. Based on your description, it seems you are experiencing a combination of physical and possibly psychological factors that contribute to your discomfort and hygiene concerns.

Causes of Incomplete Cleaning
1. Anatomical Factors: The anatomy of the rectal area can make it difficult to clean thoroughly. The presence of folds and creases in the anal canal can trap fecal matter, making it challenging to achieve a clean wipe with toilet paper alone. This is especially true if you are using standard toilet paper, which may not be effective in reaching all areas.

2. Bowel Habits: You mentioned experiencing mild constipation and having bowel movements every two days. Infrequent bowel movements can lead to harder stools, which may not fully evacuate the rectum. This can result in residual fecal matter that is difficult to clean. Additionally, the straining associated with constipation can lead to anal fissures or hemorrhoids, which can cause discomfort and make cleaning more painful.

3. Hygiene Practices: Over-washing or using harsh soaps can irritate the sensitive skin around the anus. As your doctor advised, excessive cleaning can disrupt the natural balance of bacteria and moisture in the area, potentially leading to irritation or infection. It’s essential to find a balance in your hygiene routine that maintains cleanliness without causing irritation.

4. Psychological Factors: Your concerns about cleanliness may also be influenced by anxiety or obsessive-compulsive tendencies. The fear of not being clean can lead to compulsive behaviors, such as excessive wiping or washing, which can exacerbate irritation and discomfort. This cycle can create a heightened sensitivity to sensations in the anal area, leading to a perception of incomplete cleaning.

Recommendations for Management
1. Gentle Cleaning Techniques: After bowel movements, consider using a bidet or a handheld showerhead to rinse the area gently with warm water. This can help remove residual fecal matter without the need for excessive wiping. If a bidet is not available, using moistened wipes (preferably unscented and alcohol-free) can be a gentler alternative to toilet paper.

2. Dietary Adjustments: To address your mild constipation, focus on increasing your fiber intake through fruits, vegetables, and whole grains. Staying hydrated is also crucial, as adequate fluid intake can help soften stools and promote regular bowel movements.

3. Mindfulness and Relaxation Techniques: If anxiety about cleanliness is affecting your daily life, consider practicing mindfulness or relaxation techniques. Cognitive-behavioral therapy (CBT) can also be beneficial in addressing obsessive thoughts and compulsive behaviors related to hygiene.

4. Consultation with a Specialist: Since you have a history of gastrointestinal evaluations, it may be worthwhile to consult with a gastroenterologist or a colorectal specialist again. They can perform a thorough examination to rule out any underlying conditions that may be contributing to your symptoms.

5. Avoid Harsh Products: Be cautious with the use of soaps and other cleansing products in the anal area. Opt for gentle, fragrance-free products to minimize irritation.

Conclusion
In summary, the issues you are experiencing with incomplete cleaning after bowel movements may stem from a combination of anatomical, dietary, and psychological factors. By adopting gentler cleaning methods, improving your diet, and addressing any underlying anxiety, you can work towards alleviating your symptoms. If the problem persists, seeking further medical advice is essential to ensure there are no underlying health concerns. Remember, maintaining a healthy balance in hygiene practices is key to preventing irritation and discomfort in the anal region.

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