Persistent Urge to Defecate: Gastrointestinal Concerns

Persistent urge to defecate regardless of whether bowel movements have occurred?

Hello, Doctor: I am a 26-year-old male, 172 cm tall and weighing 93 kg.
My occupation primarily involves mental activities, and I have a sedentary lifestyle, especially in front of the computer, with very little physical exercise and frequent late nights.
I do not smoke, drink alcohol, or consume coffee.
My diet mainly consists of rice, vegetables, and fruits.
I often read books or newspapers for about half an hour while having a bowel movement.
I have a single, steady sexual partner, and the frequency of sexual activity has been quite consistent over the years, averaging about three to four times a day (including masturbation and sexual intercourse).
Additionally, I have been using the weight loss medication Nometine as prescribed by my doctor for about three weeks.

About a week ago, I started experiencing a persistent, albeit mild, tingling sensation of urgency to defecate, similar to the feeling of constipation when a small stool is stuck at the anal opening but cannot be expelled.
However, this urge seems unrelated to whether I actually have a bowel movement.
My bowel habits are generally good, with no constipation, and when I do have a bowel movement, it is usually very smooth.
Nevertheless, regardless of whether I have had a bowel movement, this urge persists.
On days when I have already had a bowel movement, attempting to defecate again yields no stool.
Although there is no intense discomfort, the continuous urge feels almost like a persistent annoyance, which is quite bothersome to me.
I am unsure if my condition could be related to hemorrhoids or if there might be other underlying issues.
Thank you for your response, Doctor.

Mi Wan, 20~29 year old female. Ask Date: 2005/05/18

Dr. Yuan Hongdao reply Gastroenterology and Hepatology

Hello, if you have the urge to defecate but cannot, it may be necessary to consider rectal inflammation, foreign bodies in the rectum, external pressure on the rectum, or sensitivity of the nerves.
I recommend moderate exercise, drinking plenty of water, and increasing your intake of vegetables and fruits.
If there is still no improvement, you may want to consult a colorectal surgeon to see if a rectoscopy is needed.
Hemorrhoids typically do not present with such symptoms, but it is still important to seek medical evaluation to check for hemorrhoids, their size, location, and whether there are any thromboses, etc.
Sincerely, Dr.
Yuan Hongdao, Internal Medicine.

Reply Date: 2005/05/18

More Info

The symptoms you are experiencing, particularly the persistent urge to defecate accompanied by a mild discomfort, can be quite distressing and may stem from various gastrointestinal issues. Given your age and lifestyle, it is essential to consider several factors that could contribute to your condition.

Firstly, the sensation of needing to defecate without the ability to do so can be indicative of several conditions. One possibility is irritable bowel syndrome (IBS), a functional gastrointestinal disorder characterized by symptoms such as abdominal pain, bloating, and altered bowel habits. IBS can lead to a feeling of incomplete evacuation, which might explain the persistent urge you are experiencing. Stress and lifestyle factors, such as prolonged sitting and lack of physical activity, can exacerbate IBS symptoms.

Another consideration is rectal sensitivity or anismus, where the rectum becomes overly sensitive, leading to a constant urge to defecate even when the bowel is empty. This condition can be associated with anxiety or stress, which may be heightened by your sedentary lifestyle and irregular sleep patterns.

Additionally, while you mentioned that you do not have a history of hemorrhoids, they can still develop due to straining during bowel movements or prolonged sitting. Hemorrhoids can cause discomfort and a sensation of fullness in the rectal area, which might be perceived as an urge to defecate.

Your diet, primarily consisting of rice, vegetables, and fruits, is generally healthy; however, it is crucial to ensure you are consuming enough fiber and staying well-hydrated. Insufficient fiber intake can lead to changes in bowel habits and may contribute to feelings of incomplete evacuation. Consider incorporating more whole grains, legumes, and nuts into your diet, as these can help regulate bowel movements.

The use of weight loss medications like Orlistat (known as "诺美婷" in your context) can also affect gastrointestinal function. Side effects may include changes in bowel habits, which could contribute to your symptoms. If you suspect that the medication is influencing your gastrointestinal health, it would be wise to discuss this with your prescribing physician.

In terms of self-management, here are some strategies you might consider:
1. Increase Physical Activity: Regular exercise can help stimulate bowel function and reduce stress, which may alleviate some of your symptoms.

2. Dietary Adjustments: Ensure you are consuming adequate fiber and fluids. Aim for a balanced diet that includes a variety of food groups.

3. Stress Management: Techniques such as mindfulness, meditation, or yoga can help manage stress levels, which may, in turn, reduce gastrointestinal symptoms.

4. Regular Bowel Habits: Establish a routine for bowel movements, allowing yourself time to relax and not rush the process.

5. Avoid Prolonged Sitting: Take breaks to stand and move around, which can help alleviate pressure on the rectal area.

If your symptoms persist or worsen, it is crucial to consult a healthcare professional for a thorough evaluation. They may recommend further investigations, such as a colonoscopy, to rule out any underlying conditions. It is essential to address these symptoms early to prevent potential complications and improve your quality of life.

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