Constipation: When to Seek Help for Changes in Bowel Movements

I would like to inquire about issues related to bowel movements (constipation) and difficulties?

Hello doctor, I have a constipation issue and often have no urge to defecate, going less than 3 to 4 times a week, and it is difficult to pass stool.
I often have to exert a lot of effort to successfully have a bowel movement.
Recently, over the past 1 to 2 weeks, I have noticed that my stools have become thinner! The process of defecation remains very difficult, requiring significant effort, and the amount is very small.
Additionally, after I finish, I often feel the urge again as soon as I drink water or eat, which is quite different from before.
Previously, I had no urge to defecate, but now I feel the urge but still cannot pass anything.
Before I have a bowel movement, I frequently feel as if something is blocking my anus, and my buttocks feel sore, which is strange.
After I finish, that feeling diminishes, but it returns whenever I drink water or eat.
My stomach always feels very bloated, which is quite distressing.
I am wondering if this worsening of my constipation could have caused polyps, leading to my stools becoming thinner? I currently have no bleeding.
Should I observe this for a few days or weeks, or should I seek medical attention immediately? I am very reluctant to undergo a colonoscopy.
If there are ways to improve this without a colonoscopy, could you please advise? Thank you, doctor, for your response.

Xiangchang, 30~39 year old female. Ask Date: 2021/03/06

Dr. Chen Shidian reply Gastroenterology and Hepatology

You can first check for occult blood in the stool.

Reply Date: 2021/03/06

More Info

Understanding constipation and changes in bowel movements is crucial for maintaining gastrointestinal health. Your symptoms, including infrequent bowel movements, difficulty passing stools, and the recent change in stool caliber, warrant careful consideration.
Constipation is generally defined as having fewer than three bowel movements per week, and it can be accompanied by straining, hard stools, and a sensation of incomplete evacuation. The fact that you are experiencing a change in the shape of your stools, particularly if they have become thinner, can be concerning. In some cases, a change in stool caliber may indicate an obstruction in the colon, such as a polyp or other mass, which can narrow the passageway.

The sensation of having something stuck in the rectum, along with the feeling of pressure and discomfort in your abdomen, further complicates your situation. These symptoms can be indicative of several underlying issues, including functional gastrointestinal disorders, such as irritable bowel syndrome (IBS), or structural problems like rectal prolapse or strictures.

Given that you have not experienced any bleeding, which is a positive sign, it is still essential to monitor your symptoms closely. However, the presence of thin stools, particularly if they are consistently thin, should not be ignored. While it is understandable that you may be hesitant to undergo a colonoscopy, this procedure is the gold standard for diagnosing potential abnormalities in the colon, including polyps or tumors.
In terms of management, there are several strategies you can consider to alleviate your symptoms and improve your bowel habits:
1. Dietary Changes: Increasing your fiber intake can help soften stools and promote regular bowel movements. Aim for a diet rich in fruits, vegetables, whole grains, and legumes. Additionally, staying well-hydrated is crucial, as adequate fluid intake can help prevent constipation.

2. Physical Activity: Regular exercise can stimulate bowel function and help alleviate constipation. Aim for at least 30 minutes of moderate exercise most days of the week.

3. Over-the-Counter Laxatives: If dietary changes and increased physical activity do not provide relief, you may consider using over-the-counter laxatives. Options include fiber supplements, osmotic laxatives (like polyethylene glycol), or stimulant laxatives. However, these should be used sparingly and not as a long-term solution.

4. Stress Management: Since you mentioned experiencing anxiety, it may be beneficial to explore stress management techniques such as mindfulness, yoga, or cognitive-behavioral therapy. Stress can significantly impact gastrointestinal function and may contribute to your symptoms.

5. Regular Bowel Habits: Establishing a routine for bowel movements can be helpful. Try to set aside time each day to sit on the toilet, even if you do not feel the urge to go. This can help train your body to recognize when it is time to have a bowel movement.

If your symptoms persist or worsen, or if you begin to experience additional symptoms such as weight loss, changes in appetite, or rectal bleeding, it is crucial to seek medical attention promptly. While it may be uncomfortable, a colonoscopy can provide valuable information about your gastrointestinal health and help rule out any serious conditions.

In conclusion, while lifestyle modifications can significantly improve your symptoms, it is essential to remain vigilant and consult a healthcare professional if your condition does not improve. Early intervention can lead to better outcomes and peace of mind regarding your gastrointestinal health.

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