Struggling with Constipation: When to Consider Surgery?

I have been wanting to have a bowel movement but can't seem to do so?

I constantly feel the urge to have a bowel movement, but I am unable to do so when I sit on the toilet.
I have a habit of using enemas.
Previously, a gastroenterologist mentioned that there was nothing in my intestines to pass.
The doctor only prescribed hemorrhoid cream.
Although I have applied the cream, I still experience swelling in the anal area and a strong urge to have a bowel movement, which is very uncomfortable.
Do I need to consider surgery for removal?

Wang Wang, 20~29 year old female. Ask Date: 2021/01/21

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello, I have been experiencing difficulty with bowel movements and discomfort due to anal swelling.
I am a 25-year-old female, and the most common cause of these symptoms is hemorrhoids.
Warm sitz baths, topical ointments, and certain medications can help alleviate symptoms by promoting relaxation and reducing pressure in the anal area.
In terms of lifestyle habits, it is recommended to avoid prolonged sitting or standing, stay well-hydrated, consume a high-fiber diet, and establish regular bowel habits.
Surgical or minimally invasive procedures should only be considered for severe hemorrhoids, such as grade IV, when other treatments are ineffective, or if there are concurrent anal conditions.
A professional evaluation by a physician is necessary.
Wishing you safety and good health! Dr.
Ming-Hui Lin, Attending Physician, Gastroenterology Department, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2021/01/21

More Info

When dealing with persistent constipation, especially when accompanied by a sensation of needing to defecate without success, it is crucial to explore all possible treatment options before considering surgery. Constipation can stem from various causes, including dietary habits, lifestyle factors, and underlying medical conditions.
In your case, it seems that you have already consulted a gastroenterologist who indicated that there is nothing in your intestines to pass. This suggests that your constipation may not be due to a blockage but rather a functional issue, which is common. The use of enemas can provide temporary relief, but relying on them frequently can lead to dependency and may worsen the situation over time.

The fact that you are experiencing discomfort and swelling around the anus, despite using a hemorrhoid ointment, indicates that there may be additional factors at play. Hemorrhoids can cause significant discomfort and may contribute to the sensation of needing to defecate. However, if the primary issue is functional constipation, surgery may not be the best solution.

Before considering surgical options, here are some steps you might take:
1. Dietary Changes: Increasing your fiber intake can help improve bowel movements. Foods rich in fiber, such as fruits, vegetables, whole grains, and legumes, can promote regularity. Additionally, staying hydrated is crucial, as adequate water intake helps soften stool.

2. Physical Activity: Regular exercise can stimulate bowel function. Even simple activities like walking can make a difference.

3. Medications: If over-the-counter treatments have not provided relief, you might discuss prescription options with your doctor. Laxatives, stool softeners, or medications that stimulate bowel movements may be appropriate.

4. Behavioral Techniques: Establishing a regular bathroom routine can help train your body to have more consistent bowel movements. This includes setting aside time each day to sit on the toilet, even if you don’t feel the urge to go.

5. Further Evaluation: If your symptoms persist, further evaluation may be necessary. This could include tests to assess bowel function, such as a colonoscopy, anorectal manometry, or imaging studies to rule out any anatomical issues.

Surgery is typically considered a last resort for constipation and is usually reserved for cases where there is a clear anatomical problem, such as a rectal prolapse or severe pelvic floor dysfunction. Surgical options may include procedures to remove impacted stool or to correct structural issues, but these come with their own risks and recovery times.

In summary, while surgery is an option for some cases of constipation, it is essential to exhaust non-surgical treatments first. If your symptoms continue to interfere with your quality of life, it may be beneficial to seek a second opinion from a gastroenterologist or a colorectal surgeon who specializes in functional bowel disorders. They can provide a comprehensive evaluation and discuss the most appropriate treatment options tailored to your specific situation.

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