Bowel Issues: Hemorrhoids, Constipation, and Treatment Options

Bowel movements and issues related to hemorrhoids and gastrointestinal medications?

I am currently 28 years old.
Previously, I experienced a week without bowel movements, accompanied by abdominal discomfort (bloating).
After consulting a gastroenterologist and undergoing X-ray examinations that showed no abnormalities except for some retained stool, I was prescribed medication.
After taking the medication, I began to have daily bowel movements (with the urge to defecate).
However, a week later, I started experiencing urgency and frequency of urination, prompting me to see a urologist.
Urine, blood tests, and X-ray examinations revealed no abnormalities.
After discussing my medical history, the doctor suggested a referral to colorectal surgery.
During this period, my bowel movements were intermittent, and I often experienced gastrointestinal bloating, but I never went more than three days without a bowel movement; the urgency and frequency of urination resolved a week later.
The colorectal surgery department scheduled a colonoscopy (on 8/31) and prescribed Normacol Plus Granule.
After taking it, my bowel movements became more regular (though the shape of the stool was inconsistent).
I would feel the urge to defecate every morning after waking up, after breakfast, and after lunch; however, the urge after dinner was not consistent.
I had bowel movements 3 to 4 times a day, occasionally 5 times.
Since the colonoscopy, I stopped taking Normacol Plus Granule, but I generally continued to follow the same bowel movement pattern, except for yesterday (9/13) and today (9/14) when I did not feel much urge to defecate upon waking.
Yesterday (9/13), I returned to review the colonoscopy report, which indicated only mild internal hemorrhoids, with no other abnormalities found.
After explaining my recent bowel habits (from 8/31 to 9/13) to the doctor, I was prescribed a 21-day supply of Normacol Plus Granule and Biofermin-R Powder, with no follow-up appointment required.

I have several questions for Dr.
Ke:
1.
I feel the urge to defecate but cannot pass stool (I do not feel the presence of stool).
After sleeping, I no longer feel the urge.
Additionally, passing gas makes the urge less noticeable.
Is this caused by internal hemorrhoids?
2.
I feel the urge to defecate but cannot pass stool (I do feel the presence of stool).
The urge immediately subsides after a bowel movement.
Is this due to the stool being too dry and hard? Is this considered constipation or a precursor to constipation?
3.
Additionally, sometimes passing gas relieves or reduces the urge to defecate.
Could this be caused by internal hemorrhoids?
4.
I experience anal itching, a sensation of a foreign body when tightening the anus, and slight pain (very mild).
Is this also caused by internal hemorrhoids?
5.
Does mild internal hemorrhoids require treatment (especially since there has been no bleeding)? I am particularly concerned about questions 1 to 4, especially regarding the sensation of urgency.
If surgery is not performed, is there a high chance of self-healing? Or can the discomfort be alleviated to the point of having no symptoms? If surgery is necessary, what methods are generally recommended?
6.
The shape of my stool is inconsistent; sometimes it is a complete log, other times it is in two or more pieces, or it can be loose, long and thin, or mushy (these three types often come out with a lot of gas and stool).
Could an imbalance in gut bacteria cause this condition? (This has not occurred in the past few months, and I have not been diagnosed with irritable bowel syndrome; it has been this way since my bowel movements became regular.)
7.
I have a long history of prolonged sitting and squatting (currently experiencing soreness in my buttocks).
Could this affect the pelvic muscles and cause constipation? Should I seek treatment from a rehabilitation specialist for the soreness?
8.
Does prolonged sitting and squatting exacerbate the condition of internal hemorrhoids? If so, how often should I get up to move around? What is the minimum duration for activity? How can I relieve the soreness in my buttocks?
9.
Since the onset of constipation, the sensation of urgency is not as strong as before; I do not feel a strong urge to defecate.
Is this related to the frequency of bowel movements (previously once every 1 to 4 days) or a functional issue? Can training the abdominal muscles/transverse abdominis enhance the sensation of urgency?
10.
Normacol Plus Granule contains laxative ingredients.
Will long-term use (over one month or even six months) have adverse effects on the gastrointestinal tract (e.g., slowed gastrointestinal motility, black bowel syndrome, etc.)? When is the best time to take Normacol Plus Granule for optimal effect? (The medication bag states to take it immediately after meals but does not specify whether to take it after breakfast, lunch, or dinner.)
11.
My bowel movements are currently relatively regular.
Is it necessary to continue taking Normacol Plus Granule? If I do not have a bowel movement for three consecutive days, is it acceptable to take one packet on the fourth day or to take it continuously for three days? Or should I finish the 21-day supply of Normacol Plus Granule before returning to the colorectal surgery department for evaluation?
12.
Are there any other (pure fiber, non-laxative) alternative medications covered by health insurance besides Normacol Plus Granule?

Niming, 20~29 year old female. Ask Date: 2022/09/14

Dr. Ke Fangxu reply Surgery

1.
It should be 2.
This is the normal rectal distension reflex caused by feces entering the rectum, which leads to rectal distension and the sensation of urgency.
3.
Similarly, both gas and solid matter can trigger the distension reflex.
4.
It could be 5.
Surgery is not necessary; postoperative discomfort may be worse than the current condition.
6.
I believe it is normal.
7.
Long periods of sitting or squatting should be avoided; rehabilitation or strength training to strengthen the pelvic floor is also beneficial.
8.
Walking for ten minutes every hour and applying heat.
9.
The issue is functional; strengthening the abdominal muscles will not enhance the urge to defecate.
Lifestyle and dietary habits should be improved.
10.
It can happen in the morning or evening; observe bowel habits.
If the habit is to defecate in the morning, eat in the evening, and vice versa, also consider the timing of medication response.
11.
If sufficient dietary fiber is consumed, the medication can be discontinued at any time, or the daily dosage can be reduced.
12.
There are many pure fiber products, but if they do not contain laxatives, the National Health Insurance Administration does not recognize them as medications and will not reimburse them.
You can check with the pharmacy for more information.

Reply Date: 2022/09/14

More Info

Understanding bowel issues, especially those related to hemorrhoids, constipation, and treatment options, can be quite complex. Your situation involves a combination of symptoms that may be interrelated, and it’s important to address each aspect thoroughly.

1. Feeling of Urgency Without Output: The sensation of having a bowel movement without being able to produce stool can indeed be linked to internal hemorrhoids. Hemorrhoids can cause discomfort and a feeling of fullness in the rectal area, which may lead to confusion about whether a bowel movement is necessary. This sensation can also be exacerbated by gas, which may create pressure in the abdomen and affect the perception of bowel urgency.

2. Hard Stools and Constipation: If you feel the urge to defecate but can only produce hard stools, this is a classic sign of constipation. Hard stools can lead to straining during bowel movements, which can further aggravate hemorrhoids and lead to pain or bleeding. This situation can be considered a precursor to constipation, especially if it occurs frequently.

3. Gas and Urgency: The relationship between gas and the sensation of needing to defecate can be complex. Gas can sometimes relieve the pressure in the rectum, leading to a temporary reduction in the urge to defecate. However, if this is a recurring issue, it may indicate that your bowel function is not optimal, potentially due to the presence of hemorrhoids or other gastrointestinal issues.

4. Anal Itching and Discomfort: The symptoms of anal itching, a sensation of a foreign body, and mild pain can also be attributed to hemorrhoids. These symptoms are common and can be exacerbated by irritation from hard stools or excessive wiping. Maintaining good hygiene and using topical treatments as prescribed can help alleviate these symptoms.

5. Management of Mild Hemorrhoids: Mild internal hemorrhoids often do not require surgical intervention, especially if they do not cause significant bleeding or pain. Conservative management, including dietary changes to increase fiber intake, adequate hydration, and the use of stool softeners, can lead to improvement. Self-resolution is possible, but it may take time, and symptoms can be managed effectively without surgery.

6. Stool Consistency and Gut Flora: The variability in stool shape and consistency can indeed be influenced by gut flora. An imbalance in gut bacteria can lead to irregular bowel habits, including the formation of hard or loose stools. Maintaining a diet rich in fiber, probiotics, and prebiotics can help restore balance and improve stool consistency.

7. Impact of Sedentary Lifestyle: Prolonged sitting or squatting can contribute to pelvic floor dysfunction, which may exacerbate constipation. Engaging in regular physical activity can help stimulate bowel movements and alleviate discomfort. If you experience persistent pain in the buttocks, consulting a physical therapist specializing in pelvic floor dysfunction may be beneficial.

8. Activity and Hemorrhoids: To prevent worsening of hemorrhoids, it's advisable to take breaks from sitting every 30 to 60 minutes. Simple movements or stretches can help improve circulation and reduce pressure in the rectal area. If you experience discomfort, consider gentle exercises or stretches that target the pelvic area.

9. Changes in Urgency: A decrease in the urgency to defecate can be related to changes in bowel habits. If you have shifted from frequent bowel movements to less frequent ones, your body may adjust to this new pattern, leading to a diminished sensation of urgency. Strengthening the abdominal and pelvic floor muscles through targeted exercises may help improve bowel function.

10. Long-term Use of Laxatives: Normacol Plus Granule contains fiber and is generally safe for long-term use. However, reliance on any laxative can lead to dependency, where the bowel becomes less responsive to natural stimuli. It’s best to use such products as a part of a broader strategy that includes dietary changes and lifestyle modifications.

11. Continuing Treatment: If your bowel movements are currently regular, you may not need to continue using Normacol Plus Granule indefinitely. However, if you experience a lapse in regularity, it may be beneficial to resume use temporarily. Always consult your healthcare provider before making changes to your medication regimen.

12. Alternative Fiber Supplements: There are several fiber supplements available that do not contain laxative properties. Options such as psyllium husk or methylcellulose can be effective in increasing fiber intake without the risk of dependency associated with stimulant laxatives.

In summary, your symptoms suggest a combination of mild hemorrhoids and functional bowel issues. A comprehensive approach that includes dietary modifications, regular physical activity, and possibly the continued use of fiber supplements can help manage your symptoms effectively. Regular follow-up with your healthcare provider is essential to monitor your condition and make necessary adjustments to your treatment plan.

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