Overcoming Constipation and Hemorrhoid Discomfort: Expert Advice

Difficulty in bowel movements and anal discomfort?

Hello Doctor: I have had bowel movement issues since childhood, and due to recurrent allergic purpura, I have been seeing doctors regularly and taking medications such as probiotics and stool softeners to help with bowel movements.
It wasn't until middle school, when my bowel movements improved and my allergic purpura stabilized, that my doctor said I could stop regular check-ups and discontinue medication.
However, I still have bowel movement problems; although I can have a bowel movement every day, I do not easily feel the urge to go.
My gastrointestinal motility is very slow, and I need to sit on the toilet for a long time to "prepare" for a bowel movement; otherwise, I cannot feel the urge to go, which makes my bathroom visits very lengthy, and I have developed a habit of recognizing the toilet.
Last week, due to a five-day trip where I could not have regular bowel movements, my stool became very hard and difficult to pass.
After the bowel movement, I experienced slight bleeding from the anus and a feeling of swelling or a foreign body.
Upon examination, I found a lump, and after researching online, I suspect it might be a prolapsed hemorrhoid (unsure if it is grade II or III).
I subsequently performed sitz baths and purchased hemorrhoid cream from the pharmacy, which alleviated the pain and swelling.
However, every time I have a bowel movement, the hemorrhoid protrudes, causing swelling and discomfort, and the process of passing stool is very challenging.
I feel as though my anus is blocked, and the stool is stuck at the anal opening, requiring significant effort and time to pass (to the point of feeling dizzy and having a headache).
Currently, I am continuing daily sitz baths and applying medication, drinking plenty of water, and taking dietary fiber supplements.
I have a bowel movement every 1-2 days, and the hemorrhoids have improved and retracted, but they still swell and hurt after each bowel movement, and the process remains very difficult.

Doctor, I would like to ask:
1.
How can I improve my bowel movement difficulties and the issue of hemorrhoids swelling and protruding after each bowel movement?
2.
Given my current situation, what measures do you recommend I take, or what should I be aware of?
3.
Is my difficulty in passing stool caused by the hemorrhoids? (Is it possible that the hemorrhoids are blocking the anal opening and causing the stool to be obstructed?)
Thank you for your answers, Doctor.

S, 20~29 year old female. Ask Date: 2024/02/02

Dr. Zhang Shuhao reply Surgery

1.
In addition to supplementing with probiotics and increasing fluid intake, it is advisable to ask a doctor for fiber supplements and stool softeners.
Engaging in regular exercise can promote gastrointestinal motility, maintain abdominal and pelvic muscle strength, and shorten the time spent in the restroom.
If discomfort is caused by hemorrhoids, warm sitz baths are recommended, and during the bath, gently push the hemorrhoids back in.

2.
It is recommended to consult a gastroenterologist or a colorectal surgeon to evaluate the condition of constipation and hemorrhoids, and to determine if a colonoscopy or treatment for hemorrhoids is necessary.
3.
Difficulty in bowel movements is usually not caused by hemorrhoids.
Constipation can exacerbate the symptoms of hemorrhoids, but hemorrhoids do not cause obstruction.

Reply Date: 2024/02/02

More Info

Constipation and hemorrhoid discomfort can significantly impact your quality of life, and it's essential to address these issues comprehensively. Based on your description, it seems you have been dealing with chronic constipation and have recently developed hemorrhoids, which are exacerbating your difficulties with bowel movements. Let's break down your concerns and explore some strategies to help you manage these conditions effectively.

1. Improving Bowel Regularity and Hemorrhoid Management
To improve your bowel regularity, consider the following strategies:
- Dietary Changes: Increasing your fiber intake is crucial. Aim for a diet rich in fruits, vegetables, whole grains, and legumes. Fiber helps to bulk up stool and promotes regular bowel movements. The recommended daily fiber intake is about 25 grams for women and 38 grams for men. Gradually increase your fiber intake to avoid gas and bloating.

- Hydration: Drinking plenty of water is essential. Aim for at least 8-10 cups of water daily. Proper hydration helps soften stool, making it easier to pass.

- Regular Exercise: Physical activity can stimulate bowel function. Aim for at least 30 minutes of moderate exercise most days of the week. Activities like walking, jogging, or yoga can be beneficial.

- Scheduled Bathroom Time: Establish a routine for bowel movements. Try to sit on the toilet at the same time each day, preferably after meals when your digestive system is most active. This can help condition your body to recognize when it’s time to go.

2. Measures and Precautions
Given your current situation with hemorrhoids, here are some additional measures you can take:
- Sitz Baths: Continue with sitz baths, as they can help soothe the area and reduce swelling. Soaking in warm water for 10-15 minutes several times a day can provide relief.

- Topical Treatments: Over-the-counter creams or ointments specifically for hemorrhoids can help alleviate pain and swelling. Ensure you apply them as directed.

- Avoid Straining: Straining during bowel movements can worsen hemorrhoids. If you feel the urge to go, try not to delay it. If you have difficulty passing stool, consider using a stool softener or a mild laxative, but consult your healthcare provider before starting any new medication.

- Positioning: When using the toilet, elevating your feet on a stool can help change the angle of your rectum, making it easier to pass stool.

3. Relationship Between Constipation and Hemorrhoids
Yes, constipation can contribute to the development and exacerbation of hemorrhoids. When stool is hard and difficult to pass, it can lead to straining, which puts pressure on the veins in the rectal area, causing them to swell and form hemorrhoids. Additionally, if you are experiencing a sensation of blockage or difficulty passing stool, it may be due to the presence of hemorrhoids, which can obstruct the passage of stool.

Conclusion
It's important to address both the constipation and the hemorrhoids simultaneously. If your symptoms persist despite these measures, or if you experience severe pain, significant bleeding, or other concerning symptoms, it is crucial to consult a healthcare professional. They may recommend further evaluation or treatment options, including prescription medications or procedures to address the hemorrhoids.

In summary, focus on dietary changes, hydration, regular exercise, and proper bathroom habits to improve your bowel regularity and manage your hemorrhoids. With consistent effort and the right strategies, you can alleviate your discomfort and enhance your overall well-being.

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