Right Lower Abdomen Swelling: Causes and Solutions - Gastroenterology and Hepatology

Swelling in the right lower abdomen?

Hello, doctor.
I would like to ask a few questions.

1.
I experience a feeling of obstruction when passing gas and having bowel movements; I have to exert a lot of force or squat to relieve myself.
My stools are either flattened or about the size of a finger, and they are not very long.
Last week, I had a colonoscopy, and the doctor said everything was fine, only noting grade III hemorrhoids, with no tumors found.
However, I read online that hemorrhoids typically do not cause these issues, and tumor pressure seems more likely.
I asked the doctor, but he was also uncertain if the hemorrhoids were the root cause.
Should I ask him to perform surgery to remove the hemorrhoids? Would that improve my condition?
2.
When I feel the urge to have a bowel movement, I experience swelling in the area just above my pubic bone and to the right of my navel, which makes me feel like I need to urinate.
This sensation disappears after I have a bowel movement, and I no longer feel the urge to urinate.
Since the colonoscopy did not reveal any tumors, should I also check for tumors in the bladder? Or would it be sufficient to have the grade III internal hemorrhoids removed to see improvement? Thank you for your answers.

Tian Liang Le, 30~39 year old female. Ask Date: 2020/10/29

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello, a 32-year-old male is experiencing constipation and has grade III hemorrhoids.
Straining during bowel movements can exacerbate the hemorrhoids, and severe hemorrhoids can sometimes lead to difficulties in passing stool.
Causes of constipation may include dietary habits, intra-abdominal infections, gastrointestinal dysfunction, medications, and endocrine disorders.
For hemorrhoid treatment, it is generally recommended to first try non-surgical methods; if there is no improvement, then surgical intervention may be considered.
It is advised to follow up with a colorectal specialist regarding any new treatment options for hemorrhoids.
To alleviate constipation, attention should be paid to diet, including increased water intake, fiber consumption, and reduced intake of spicy foods, smoking, and alcohol.
Severe hemorrhoids may sometimes require surgery, but it is essential to maintain a proper diet and monitor for any related conditions to prevent recurrence.
Wishing you peace and health! Sincerely, Dr.
Ming-Hui Lin, Attending Physician, Gastroenterology Department, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2020/10/29

More Info

When it comes to understanding right lower abdomen swelling and associated symptoms, it is essential to consider various potential causes and their implications. Based on your description, you are experiencing a sensation of blockage during bowel movements and gas expulsion, along with changes in stool shape and size. Additionally, you mentioned swelling in the lower abdomen, particularly in the area near the right lower quadrant, which seems to resolve after bowel movements.

1. Understanding the Symptoms: The symptoms you describe, such as the need to exert significant effort to pass gas or stool, and the altered stool shape, can be indicative of several gastrointestinal issues. While your recent colonoscopy showed no tumors and only revealed grade III hemorrhoids, it is important to note that hemorrhoids can contribute to discomfort and may lead to straining during bowel movements. However, they are not typically associated with significant changes in stool shape or size.
The presence of a sensation of blockage could suggest a functional gastrointestinal disorder, such as constipation or irritable bowel syndrome (IBS). In IBS, patients often experience abdominal discomfort, changes in bowel habits, and bloating. The fact that your stool is described as thin or pencil-like could also indicate a potential narrowing of the bowel lumen, which could be caused by various factors, including muscle spasms or inflammation.

2. Considering Surgical Options: Regarding your question about whether to proceed with surgery to remove the hemorrhoids, it is essential to weigh the potential benefits against the risks. Surgical intervention for hemorrhoids is typically recommended when conservative treatments (such as dietary changes, increased fiber intake, and topical treatments) have failed to provide relief. If your hemorrhoids are causing significant discomfort or contributing to your bowel issues, surgical removal may improve your symptoms. However, it is crucial to have a thorough discussion with your healthcare provider about whether the hemorrhoids are indeed the root cause of your symptoms.

3. Investigating Other Causes: The swelling you experience in the right lower abdomen, particularly when you feel the urge to defecate, could be related to several factors. While your colonoscopy did not reveal any tumors, it may be prudent to consider further evaluation of the urinary tract, especially if you are experiencing urinary symptoms. Conditions such as bladder tumors or infections can cause similar sensations and should be ruled out if symptoms persist.

It may also be beneficial to consult with a gastroenterologist or a urologist for a comprehensive evaluation. They may recommend imaging studies, such as an abdominal ultrasound or CT scan, to assess the structures in the abdomen and pelvis more thoroughly.

4. Lifestyle Modifications: In the meantime, consider implementing lifestyle changes that may alleviate your symptoms. Increasing dietary fiber can help improve stool consistency and promote regular bowel movements. Staying hydrated is also crucial. Engaging in regular physical activity can stimulate bowel function and reduce the sensation of bloating.

5. Follow-Up Care: Lastly, it is essential to maintain open communication with your healthcare provider. If your symptoms persist or worsen, or if you develop new symptoms, do not hesitate to seek further evaluation. Keeping a symptom diary may also help your doctor understand the patterns and triggers of your discomfort.

In summary, while hemorrhoids may contribute to your symptoms, it is essential to explore other potential causes and consider a comprehensive approach to your gastrointestinal health. Surgical intervention may be beneficial, but it should be part of a broader evaluation and treatment plan tailored to your specific needs.

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