Long-Term Constipation and Rectal Issues: Causes and Solutions

Chronic constipation, rectal issues?

Hello, doctor.
I am currently working abroad and unable to return to Taiwan.
I am on a waiting list to see a specialist, but due to the pandemic, I have not been able to get an appointment yet.
I have been experiencing chronic constipation for a year.
Initially, my symptoms included alternating diarrhea and constipation, but now I only have constipation.
At the beginning of 2020, due to work-related stress, I often had to suppress the urge to defecate or the urge was not very noticeable (I felt the urge, but once it reached the rectum, there was no further sensation to continue).

Now, even though I can go to the bathroom throughout the day, I have to go five to six times, and often at night, I still feel small pieces of stool stuck in the rectum that I cannot expel, which is very uncomfortable.
My rectal muscles often seem insufficient, or I cannot completely evacuate all the stool in one go.
For example, I might successfully pass one banana-sized stool, but then my rectum seems to stop working, and I cannot pass a second one, leaving me with a feeling of incomplete evacuation and discomfort.
Sometimes, after passing one or two pieces, I feel like I am done, but one or two hours later, I have the urge again, leading to having to defecate six times a day (two to three times in the morning, once at noon, and two to three times in the afternoon).

I have a bowel movement every day, with a total volume of about two to three banana-sized stools.
When my condition is better, the shape and size are similar to a banana, and the color is normal.
When my condition is worse, the stools are often small or soft and thinner.
I have undergone stool and blood tests, and everything is normal (I have to wait for a specialist to perform a colonoscopy).
I also have mild hemorrhoids.

Could you please advise what might be causing these symptoms in my intestines? Thank you for taking the time to read this, and I appreciate all the work done by those in the medical field.

Yi Hui, 30~39 year old female. Ask Date: 2021/01/09

Dr. Chen Shidian reply Gastroenterology and Hepatology

It is likely a constipation type of irritable bowel syndrome, but it is still recommended to check for occult blood in the stool to rule out colorectal disease.
Additionally, increase the intake of fruits and vegetables, engage in post-meal walking exercises, establish a regular bathroom schedule, and perform abdominal massage in a counterclockwise direction.
If these measures are ineffective, consider using prokinetic agents for bowel movement.

Reply Date: 2021/01/09

More Info

Long-term constipation and rectal issues can be quite distressing and may stem from a variety of causes. Based on your description, it seems that you have been experiencing a complex interplay of symptoms, including alternating diarrhea and constipation, followed by persistent constipation, and difficulties with rectal evacuation. Here’s a comprehensive overview of potential causes and solutions for your situation.

Possible Causes
1. Functional Constipation: This is a common condition where the bowel does not function properly, leading to infrequent or difficult bowel movements. Stress and lifestyle factors, such as diet and physical activity, can significantly impact bowel function.

2. Rectal Dysfunction: The sensation of incomplete evacuation and the feeling of stool being "stuck" in the rectum may indicate issues with rectal muscle function or coordination. This can be due to pelvic floor dysfunction, where the muscles do not relax properly during defecation.

3. Irritable Bowel Syndrome (IBS): Your initial symptoms of alternating diarrhea and constipation could suggest IBS, a functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits.

4. Dietary Factors: A low-fiber diet can lead to hard stools and constipation. Insufficient hydration can also exacerbate this issue.
5. Psychological Factors: Stress and anxiety can affect bowel habits. The pressure of work and the inability to respond to natural urges can lead to a cycle of constipation.

6. Anorectal Disorders: Conditions such as hemorrhoids can cause discomfort and may lead to avoidance of bowel movements, further complicating the issue.

Solutions and Recommendations
1. Dietary Changes: Increasing fiber intake can help improve bowel regularity. Aim for a diet rich in fruits, vegetables, whole grains, and legumes. Additionally, ensure you are drinking plenty of water throughout the day to help soften stools.

2. Regular Exercise: Physical activity can stimulate bowel function. Incorporating regular exercise into your routine can help alleviate constipation.

3. Scheduled Bathroom Time: Establishing a routine for bowel movements can help train your body. Try to set aside time each day, especially after meals, to encourage regularity.

4. Pelvic Floor Exercises: If rectal dysfunction is suspected, pelvic floor exercises (such as Kegel exercises) may help strengthen the muscles involved in bowel movements.

5. Laxatives or Stool Softeners: Over-the-counter options like fiber supplements, osmotic laxatives (e.g., polyethylene glycol), or stool softeners can be helpful. However, these should be used under the guidance of a healthcare provider, especially for long-term use.

6. Consultation with a Specialist: Since you are waiting for a specialist appointment, it’s crucial to keep that appointment for a thorough evaluation, including potential tests like a colonoscopy to rule out any underlying conditions.

7. Managing Stress: Consider stress management techniques such as mindfulness, yoga, or counseling, which can help improve your overall well-being and potentially alleviate some gastrointestinal symptoms.

8. Monitoring Symptoms: Keep a diary of your bowel habits, dietary intake, and any associated symptoms. This information can be invaluable for your healthcare provider in diagnosing and treating your condition.

Conclusion
Your symptoms suggest a multifactorial issue that may involve functional bowel disorders, dietary habits, and possibly psychological factors. While waiting for your specialist appointment, implementing dietary changes, increasing physical activity, and establishing a regular bathroom routine may provide some relief. It’s essential to communicate openly with your healthcare provider about your symptoms and any changes you notice, as this will aid in developing an effective treatment plan tailored to your needs.

Similar Q&A

Understanding Anal Health Issues from Long-Term Constipation Habits

Long-term habits of withholding bowel movements can lead to several anal conditions. In your case, the history of constipation during childhood may have contributed to issues such as anal fissures, hemorrhoids, or even fecal impaction, which can result in abnormal odors and disch...

Dr. Hou Yongji reply Surgery
Dear netizen: 1. Please consult a colorectal surgeon for a detailed evaluation. 2. Is "holding in bowel movements" referring to constipation? I cannot provide further explanation without understanding its meaning. 3. Our hospital's website contains some educational...

Understanding Long-Term Constipation: Causes, Effects, and Solutions

1. I have been experiencing chronic constipation for over 20 years, primarily straining to have bowel movements, which has led to decreased bowel function. Now my stools are soft, and sometimes I experience cramping diarrhea that I cannot pass without taking a deep breath. What c...

Dr. Lin Minghui reply Gastroenterology and Hepatology
1. After abdominal surgery, the intestines are more prone to adhesions, leading to chronic constipation. Sometimes, holding one's breath can increase abdominal pressure, which may assist in bowel movements. 2. A barium enema is an examination of the lower gastrointestinal ...

Understanding Long-Term Constipation: Causes and Solutions

Hello, I have undergone a colonoscopy, and my stool tests were normal, but it seems I have colonic inertia. Every time I eat, I immediately feel the urge to have a bowel movement, but I can't pass stool. I have taken some medications that were effective initially, but they e...

Dr. Chen Qifeng reply Gastroenterology and Hepatology
Poor gastrointestinal function and rectal dysfunction should start with pelvic floor exercises to enhance rectal function. Best regards, Dr. Chi-Feng Chen, Taoyuan General Hospital, Department of Health.

Understanding Chronic Constipation: Causes, Treatments, and Solutions

Dear Dr. Tsai, I have been experiencing long-term constipation issues (lack of bowel urge). I am currently 30 years old, and this problem has been present since my university days. I previously had a habit of using stimulant laxatives (such as Sennosides) for a long time, but th...

Dr. Cai Anshun reply Gastroenterology and Hepatology
Hello: 1. It may not be noticeable. 2. If kidney function is normal, magnesium oxide can be used. 3. Irritable bowel syndrome is diagnosed based on recurrent and periodic symptoms, and colonoscopy is used to rule out abnormalities in the colon (such as tumors or colitis). Changhu...