Narrow Stools: Causes and When to Seek Help

Stool becomes thin?

Hello, doctor.
About a month ago, I experienced a very large bowel movement that was difficult to pass, resulting in a tear in my anus that bled significantly.
I didn't think much of it at the time, but I became afraid of the pain and avoided going to the bathroom, which led to my stools becoming thinner and requiring more effort to pass over the next month.
The color of my stools is normal, and there is no more blood, but I still feel like I can't empty my bowels completely, and I often have difficulty with stool getting stuck at the anal opening.
I consulted a local gastroenterologist, who prescribed a three-day course of anti-inflammatory and anti-swelling medication along with hemorrhoid ointment.
After taking the medication, my stools became slightly thicker, but I still had to exert a lot of effort to pass them.
After finishing the medication, I even experienced severe constipation, going three days without a bowel movement and having no urge to go.
What could be the issue? I'm very distressed and wondering if I should schedule a colonoscopy.

Chin, 30~39 year old female. Ask Date: 2023/09/03

Dr. Zhang Shuhao reply Surgery

You can first visit a colorectal clinic to check if straining during bowel movements is causing bleeding around the anus.
If there is a noticeable area of bleeding, treatment for anal fissures can be initiated, along with addressing the constipation issue.
If there are no bleeding lesions in the anus and the constipation problem remains unresolved, then further evaluation with a colonoscopy may be necessary.

Reply Date: 2023/09/03

More Info

Narrow stools can be a concerning symptom, especially when accompanied by pain, bleeding, or changes in bowel habits. In your case, it seems that the initial experience of passing a large stool led to an anal fissure, which can cause significant discomfort and may lead to a fear of bowel movements. This fear can create a cycle of constipation, where the stool becomes harder and narrower over time due to straining and inadequate bowel movements.

The fact that you experienced bleeding initially is important. Anal fissures can cause bleeding, and they often lead to a tightening of the anal sphincter, which can make subsequent bowel movements painful and difficult. This can result in a reluctance to pass stool, leading to further constipation and the formation of narrower stools.

Narrow stools can sometimes indicate a blockage or narrowing in the colon, which could be due to various reasons, including strictures, tumors, or other conditions affecting the intestines. However, in many cases, they can also be a result of dietary factors, dehydration, or the aforementioned fear of pain leading to constipation.

Given that you have already seen a gastroenterologist and received treatment for inflammation and hemorrhoids, it’s crucial to monitor your symptoms closely. If your stools remain narrow, if you continue to experience significant pain, or if you notice any new symptoms such as weight loss, persistent abdominal pain, or changes in appetite, it would be wise to pursue further evaluation.

A colonoscopy is a valuable tool for assessing the health of your colon and can help identify any underlying issues that may be contributing to your symptoms. It is generally recommended if there are concerning symptoms, especially if there is a change in bowel habits, unexplained weight loss, or if you are over the age of 50, as a precautionary measure for colorectal cancer screening.

In the meantime, here are some strategies you can consider to help alleviate your symptoms:
1. Increase Fiber Intake: Aim for a diet high in fiber, which can help soften stools and make them easier to pass. Foods such as fruits, vegetables, whole grains, and legumes are excellent sources of fiber.

2. Stay Hydrated: Drinking plenty of water is essential for preventing constipation. Aim for at least 8-10 glasses of water a day.

3. Regular Exercise: Physical activity can help stimulate bowel function and reduce constipation.

4. Avoid Straining: If you feel the urge to go, try not to hold it in. Use a stool softener or a gentle laxative if necessary, but consult your doctor before starting any new medication.

5. Warm Baths: Soaking in a warm bath can help relax the anal sphincter and may provide relief from pain associated with fissures.

6. Follow-Up with Your Doctor: Since your symptoms have persisted and even worsened, it’s important to keep your healthcare provider informed. They may recommend further diagnostic tests or adjustments to your treatment plan.

In conclusion, while narrow stools can be a benign issue related to diet and lifestyle, they can also indicate more serious conditions. Given your history of anal fissure and ongoing symptoms, it is advisable to discuss the possibility of a colonoscopy with your doctor to rule out any serious underlying issues. Your health and comfort are paramount, so seeking further evaluation is a prudent step.

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