Struggling with Constipation and Hemorrhoids: Causes and Solutions

Constipation and hemorrhoids?

Hello, Doctor.
Due to recognizing the toilet, I have not had a bowel movement for four consecutive days during my trip.
My stool is too hard, making the process of defecation very difficult.
The stool gets stuck at the anal opening, requiring manual assistance to remove the overly hard part, which is time-consuming and laborious, and it causes anal pain.
After defecating, there is slight bleeding, and I feel a foreign body sensation in the anus.
Upon examination, I found a swollen small lump, which I researched online and seems to be a prolapsed hemorrhoid.
I have tried to push it back in and have been continuing sitz baths and using hemorrhoid cream.
The pain and swelling have improved, and the hemorrhoid can mostly retract (after a bowel movement, I gently push it back in, and after a sitz bath and applying medication, the remaining swelling gradually subsides on its own).
However, defecation is still very difficult and time-consuming, with stool getting stuck at the anal opening, feeling blocked, and requiring significant effort to the point of dizziness.
Additionally, there is pain during defecation, and the hemorrhoid swells and protrudes again afterward.
This has been ongoing for about a week (with 3-4 bowel movements).
My past condition includes weak gastrointestinal function, prone to bloating, and difficulty feeling the urge to defecate, often needing to sit on the toilet for a long time to have a bowel movement, but I can still have daily bowel movements.
Currently, I am continuing daily sitz baths and applying ointment, with bowel movements every two days (I am somewhat afraid to defecate, and it is difficult, requiring a lot of effort, which causes dizziness and headaches).

I have the following questions:
1.
How can I resolve the difficulty in defecation and the swelling and protrusion of hemorrhoids after bowel movements?
2.
Is the difficulty in defecation caused by the hemorrhoids? (For example, is the anus blocked by the hemorrhoids?)
3.
If the condition of the swollen hemorrhoids improves, will it also improve defecation and the protrusion?
4.
Is the difficulty in defecation and the protrusion of hemorrhoids a temporary phenomenon or could it become a regular occurrence? (As this has not happened before)
5.
Are there any suggestions or precautions? (To improve or alleviate the situation, and how to determine if it is worsening?)
Thank you for your guidance, Doctor.

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

Dr. Ke Fangxu reply Surgery

1.
Young women often experience severe constipation.
It is generally recommended to increase dietary fiber intake, drink more water, and engage in physical activity; consuming yogurt can also be beneficial.
If these methods are ineffective, the use of laxatives may be necessary.
Additionally, it is important to avoid hemorrhoid swelling, as prompt intervention is the only solution.
2.
On the contrary, hemorrhoids are caused by difficulty in bowel movements.
3.
The same applies; it will not improve bowel movements but can alleviate the protrusion.
4.
If bowel habits do not improve, it may become a chronic issue.

Reply Date: 2024/02/02

More Info

Constipation and hemorrhoids are common issues that can significantly affect your quality of life. Based on your description, it seems you are experiencing a combination of constipation and hemorrhoids, which can exacerbate each other. Let's address your questions one by one.

1. How to resolve difficulty in bowel movements and the swelling of hemorrhoids post-defecation?
To alleviate constipation, it is essential to increase your dietary fiber intake. Foods rich in fiber, such as fruits, vegetables, whole grains, and legumes, can help soften your stool and promote regular bowel movements. Additionally, staying well-hydrated by drinking plenty of water is crucial. You may also consider using over-the-counter stool softeners or laxatives, but it’s best to consult a healthcare professional before starting any medication. For the hemorrhoids, continuing with sitz baths can help soothe the area and reduce swelling. Applying topical treatments specifically designed for hemorrhoids can also provide relief. If the hemorrhoids are persistent or severe, it may be necessary to consult a healthcare provider for further evaluation and treatment options.

2. Is the difficulty in bowel movements caused by hemorrhoids?
Yes, hemorrhoids can contribute to difficulty in bowel movements. When hemorrhoids are swollen, they can create a feeling of obstruction in the anal canal, making it painful to pass stool. This discomfort can lead to a cycle of straining during bowel movements, which can further aggravate the hemorrhoids. The pain and fear of exacerbating the hemorrhoids can lead to avoidance of bowel movements, resulting in constipation.

3. If the swelling of hemorrhoids improves, will it also improve bowel movements and the issue of them falling out?
Yes, if the swelling of the hemorrhoids decreases, it is likely that your bowel movements will become easier and less painful. Reducing the size of the hemorrhoids can alleviate the feeling of obstruction and discomfort during defecation. This, in turn, can help you avoid straining, which is a significant factor in the worsening of hemorrhoids.

4. Is the difficulty in bowel movements and the falling out of hemorrhoids a temporary phenomenon or could it become a chronic issue?
The symptoms you are experiencing could be temporary, especially if they are related to recent changes in your bowel habits or diet. However, if the underlying issues, such as chronic constipation or poor dietary habits, are not addressed, there is a risk that these symptoms could become chronic. It is essential to adopt lifestyle changes that promote regular bowel movements and prevent the recurrence of hemorrhoids.

5. What are some recommendations or precautions?
- Dietary Changes: Increase fiber intake gradually to avoid gas and bloating. Aim for at least 25-30 grams of fiber daily.

- Hydration: Drink plenty of fluids, especially water, to help soften stool.

- Regular Exercise: Engage in regular physical activity to stimulate bowel function.

- Avoid Straining: When you feel the urge to go, try not to delay. Straining can worsen hemorrhoids and lead to further complications.

- Monitor Symptoms: Keep track of your symptoms. If you notice any significant changes, such as increased pain, persistent bleeding, or changes in bowel habits, consult a healthcare professional.

- Consult a Specialist: If your symptoms persist despite home treatment, consider seeing a gastroenterologist or a colorectal specialist for further evaluation and management.

In conclusion, addressing your dietary habits, hydration, and lifestyle can significantly improve your symptoms. If you continue to experience difficulties, do not hesitate to seek medical advice for a tailored treatment plan.

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