Digestive Discomfort: Constipation, Hemorrhoids, and More

Gastrointestinal discomfort symptoms?

Hello Dr.
Chen,
I am 22 years old and have been experiencing habitual constipation since I was 17.8 years old.
I often go 3 to 4 days, or even a week, without feeling the urge to have a bowel movement.
I have previously tried sitting on the toilet to stimulate bowel movements (as suggested in a medical column I read), but it hasn't been effective.
My average daily water intake is quite low, around 600 cc, and I consume very little fiber and rarely eat fruits, which I believe is related to my condition.

A long time ago, I noticed that I would sometimes experience bleeding when having difficulty with bowel movements, but I didn't think much of it at the time.
Now, I suspect I may have internal hemorrhoids because I can feel something resembling a polyp at the anus during bowel movements.
Could this be hemorrhoids caused by straining in the past? If it is indeed internal hemorrhoids, how should I manage this?
Additionally, sometimes when I wake up in the morning without having eaten anything, I can pass gas, but it feels more like a burp coming from my stomach to my mouth.
I've also noticed that there are times when I feel extremely hungry, but after eating a small amount of rice, I feel full and my stomach becomes bloated, sometimes to the point of discomfort.
Could this be related to peptic ulcers?
Furthermore, my grandmother passed away from colon cancer four years ago.
Is there a possibility that this could be hereditary? However, there are no other relatives in my family who have had colon cancer.
Given my symptoms, what relevant tests should I undergo? Should I consider endoscopy and colonoscopy?
Thank you for your guidance!

Gu Zui, 20~29 year old female. Ask Date: 2004/11/29

Dr. Chen Zhiping reply Gastroenterology and Hepatology

Hello, regarding your difficulty with bowel movements, it is advisable to increase your intake of fiber-rich foods, drink plenty of water, and make lifestyle adjustments to reduce stress and busyness.
The small protrusions near the anal area could be polyps, but they may also be hemorrhoids.
The main goal is to ensure smooth and soft bowel movements, and if necessary, medications can be used.
Additionally, warm sitz baths or using a bidet after using the toilet may help prevent bleeding.
It is also recommended to avoid spicy and irritating foods.
The symptoms of feeling full after eating a small amount and experiencing belching are more indicative of functional dyspepsia.
However, it is important to rule out the possibility of ulcers or other organic diseases.
You may consider undergoing an upper endoscopy or upper gastrointestinal imaging.

As for colorectal cancer, genetics play a role, and having a family history of colorectal cancer increases your risk compared to others.
Therefore, if your bowel habits do not improve or if you experience other symptoms such as a sudden change in bowel habits, blood in the stool, or weight loss, you should undergo a colonoscopy or a barium enema examination.
It may also be beneficial to perform a fecal occult blood test to check for abnormalities.
Sincerely, Dr.
Chen Zhi-Ping, Internal Medicine.

Reply Date: 2004/11/29

More Info

Hello! Thank you for your detailed inquiry regarding your digestive discomfort, which includes issues such as constipation, potential hemorrhoids, and other gastrointestinal symptoms. Let's break down your concerns and address them one by one.

Constipation and Dietary Habits
From your description, it seems that your constipation has been a long-standing issue, exacerbated by low water intake (less than 600cc daily) and a diet low in fiber and fruits. Constipation is often linked to inadequate hydration and insufficient dietary fiber, both of which are crucial for promoting regular bowel movements. The recommended daily water intake for adults is generally around 2 to 3 liters, depending on various factors such as activity level and climate. Increasing your water intake can significantly help soften your stool and promote regularity.

In addition to hydration, incorporating more fiber-rich foods into your diet is essential. Foods such as whole grains, fruits, vegetables, and legumes can help increase stool bulk and facilitate easier passage. Gradually increasing fiber intake is advisable to prevent gas and bloating, which can occur if fiber is added too quickly.

Hemorrhoids and Rectal Symptoms
You mentioned experiencing bleeding during bowel movements and noticing a protrusion that resembles a polyp. These symptoms are indeed suggestive of hemorrhoids, particularly if the bleeding is bright red and occurs during straining. Hemorrhoids can develop from prolonged straining during bowel movements, which is often a consequence of constipation.
If you suspect you have internal hemorrhoids, there are several management strategies you can consider:
1. Dietary Changes: As mentioned, increase fiber and fluid intake.

2. Topical Treatments: Over-the-counter creams or ointments can help relieve discomfort and inflammation.

3. Warm Baths: Soaking in warm water can provide relief from pain and itching.

4. Avoid Straining: Try to establish a regular bowel routine without excessive straining.

If symptoms persist or worsen, it is essential to consult a healthcare professional for a thorough evaluation and potential treatment options.

Gastrointestinal Symptoms
You also described experiencing gas that resembles belching and a sensation of fullness after eating small amounts. This could be related to several factors, including:
- Gastric Motility Issues: Conditions like gastroparesis can cause delayed stomach emptying, leading to bloating and early satiety.

- Gastroesophageal Reflux Disease (GERD): This can cause gas and discomfort, particularly if there is a backflow of stomach contents.

- Functional Dyspepsia: This encompasses a range of symptoms including bloating, discomfort, and early fullness without an identifiable cause.

Family History and Cancer Concerns
Regarding your family history of colorectal cancer, while having a relative with colorectal cancer can increase your risk, it does not guarantee that you will develop the disease. The risk is influenced by various factors, including lifestyle, diet, and genetic predispositions. Given your age and symptoms, it is prudent to discuss your family history with a healthcare provider, who may recommend screening tests such as a colonoscopy, especially if you have concerning symptoms or a significant family history.

Recommended Actions
1. Dietary Modifications: Increase fiber and fluid intake gradually.

2. Consult a Gastroenterologist: Given your symptoms, a specialist can provide a comprehensive evaluation.

3. Consider Diagnostic Tests: Depending on your doctor's assessment, they may recommend a colonoscopy or upper endoscopy (gastroscopy) to rule out any serious conditions.

4. Monitor Symptoms: Keep a record of your symptoms, dietary habits, and any changes to discuss with your healthcare provider.

In conclusion, your symptoms warrant further investigation, especially considering your family history. Making dietary changes and consulting with a healthcare professional will be crucial steps in managing your digestive health. Please take care, and I hope you find relief soon!

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