Severe Constipation: Symptoms and When to Seek Help

Constipation, with bowel movements resembling lumps of intestinal mucosa?

Hello doctor, I have had severe constipation since elementary school, and I often experience bloating, stomach pain, and vomiting that require emergency care.
In recent years, my condition has improved significantly with traditional Chinese medicine, but since the beginning of this year, I have been unable to have a daily bowel movement.
Due to discomfort from bloating, I started relying on enemas, but each time I use them, I notice fresh blood after bowel movements.
Initially, I thought it was hemorrhoids or anal fissures, but later I also expelled yellowish, mucous-like pieces resembling intestinal mucosa.
The shape of my stool varies, sometimes being in clumps and occasionally normal.
After bowel movements, I still feel a sensation of obstruction in my anus.
If I do not use enemas, I do not experience these symptoms, but without them, I have only been able to feel the urge to defecate every 3-4 days this month, and the feeling of heaviness and bloating in my abdomen is very uncomfortable.
Could this situation indicate intestinal narrowing or the presence of polyps or tumors blocking my intestines? My mother recently passed away from colon cancer at the age of 55, and I am very concerned about having a similar condition.
Should I arrange for a colonoscopy?

JOANNE, 20~29 year old female. Ask Date: 2020/08/29

Dr. Chen Shidian reply Gastroenterology and Hepatology

If concerned, you can first undergo a rectal examination (approximately 20 cm) or a sigmoidoscopy (approximately 60 cm), and use stool softeners or laxatives for adjustment/treatment.

Reply Date: 2020/08/29

More Info

Severe constipation can be a distressing condition, especially when accompanied by symptoms such as abdominal pain, bloating, and the presence of blood in the stool. Based on your description, it seems that you have been dealing with chronic constipation since childhood, which has recently worsened. The use of enemas to relieve constipation, while sometimes necessary, can lead to complications such as rectal bleeding and may mask underlying issues.

Symptoms of Severe Constipation
Severe constipation is typically characterized by:
1. Infrequent Bowel Movements: Having fewer than three bowel movements per week.

2. Straining: Difficulty or pain during bowel movements.

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

4. Abdominal Discomfort: Feelings of bloating, cramping, or pain in the abdomen.

5. Rectal Bleeding: Blood in the stool or on the toilet paper, which could indicate hemorrhoids or anal fissures.

6. Feeling of Incomplete Evacuation: A sensation that the bowel has not completely emptied after a movement.

When to Seek Help
Given your symptoms, it is crucial to seek medical attention, especially considering your family history of colorectal cancer. Here are some indicators that you should see a healthcare provider:
- Persistent Symptoms: If your constipation lasts for more than three weeks or worsens over time.

- Blood in Stool: The presence of blood, especially if it is fresh or accompanied by pain, should be evaluated.

- Unexplained Weight Loss: If you experience weight loss without trying.

- Change in Bowel Habits: Any significant change in your bowel habits, especially if you notice a shift from normal to abnormal stool consistency or frequency.

- Family History: Given your mother's history of colorectal cancer, it is prudent to be vigilant about your gastrointestinal health.

Potential Causes
Your symptoms could be indicative of several underlying issues, including:
- Intestinal Obstruction: This could be due to strictures, adhesions, or tumors that may block the passage of stool.

- Polyps or Tumors: The presence of growths in the colon can lead to changes in bowel habits and should be evaluated through colonoscopy.

- Functional Disorders: Conditions like irritable bowel syndrome (IBS) or pelvic floor dysfunction can also contribute to chronic constipation.

Recommended Actions
1. Consult a Gastroenterologist: Given your symptoms and family history, a specialist can provide a thorough evaluation. They may recommend a colonoscopy to rule out any serious conditions such as polyps or cancer.

2. Dietary Changes: Increasing fiber intake through fruits, vegetables, and whole grains can help improve bowel regularity. Staying hydrated is also crucial.

3. Medication Review: Discuss any medications you are taking with your doctor, as some can contribute to constipation.

4. Avoid Overuse of Enemas: While they can provide temporary relief, over-reliance can lead to dependency and worsen constipation.

5. Regular Exercise: Physical activity can stimulate bowel function and help alleviate constipation.

Conclusion
Your symptoms warrant a comprehensive evaluation to rule out serious conditions, especially given your family history. Do not hesitate to reach out to a healthcare provider for a thorough assessment and appropriate management. Early intervention can significantly improve your quality of life and address any underlying health concerns.

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