Painful Bowel Movements and Rectal Bleeding: Causes and Remedies

Pain and bleeding during bowel movements?

Hello Doctor, my situation is that I have a bowel movement about every two to three days, and my stools are usually quite hard, which causes pain.
When I wipe with toilet paper, there is bright red blood, about a quarter of a piece of toilet paper's worth.
After using the restroom, I still feel a noticeable wound in the anal area, but it’s not very painful, and it’s not to the point where I can't move.
It usually takes a day and a half or more before I no longer feel anything.
However, if I sometimes have a bowel movement in less than two days, even if the stool is softer, there is still some pain, but usually not much blood—just a drop or two.
Additionally, I haven't felt anything unusual around the anal area, so I’m wondering if my condition is anal fissure or hemorrhoids, or if there could be other possibilities? This situation has been ongoing for more than a year, but since I am abroad, it is really inconvenient to see a doctor, and I won’t be back in Taiwan until August, which is another six months without medical consultation.
I previously took probiotics for a month, which softened my stools and even made them a bit loose.
I had daily bowel movements, and they were indeed easier to pass.
However, I noticed that once I stopped taking probiotics, the intervals between bowel movements would extend again, and the stools would harden.
Does this mean I can’t do without probiotics? I would like to ask the doctor, since my current situation does not allow me to see a doctor, what other methods can relieve these symptoms? Are there any over-the-counter ointments I can apply, or other oral medications or suppositories? If so, I hope you can provide me with the detailed English names.
Should I continue taking probiotics? If you have any other suggestions, please let me know.
Thank you! Since I am abroad, I really don’t want to worry my parents, so whenever they ask, I say everything is fine.
I hope to resolve these symptoms before returning to Taiwan to avoid having to tell my parents that I need to see a doctor, which would only make them more worried.
Thank you for your help!

jessie, 20~29 year old female. Ask Date: 2011/03/01

Dr. Lin Minghui reply Gastroenterology and Hepatology

1.
Pain during bowel movements accompanied by a small amount of blood is commonly diagnosed as anal fissure, but differential diagnoses include hemorrhoids, proctitis, polyps, inflammatory bowel disease, and tumors.

2.
Treatment for anal fissures is recommended to include a high-fiber diet, stool softeners, and topical anesthetic ointments.
Warm sitz baths are also advised.
If these measures are ineffective, ointments containing nitroglycerin or diltiazem, which reduce anal pressure and increase blood flow, may be used.
Some patients may consider botulinum toxin injections for treatment of anal fissures, and chronic cases may require surgical intervention.
3.
Probiotics may be beneficial and can be used as needed.
Dr.
Lin Ming-Hui from Taoyuan Hospital, Department of Health, wishes you good health.

Reply Date: 2011/03/01

More Info

Based on your description, it seems that you are experiencing symptoms consistent with either anal fissures or hemorrhoids, both of which can cause rectal bleeding and pain during bowel movements. Let's break down the potential causes and remedies for your situation.

Possible Causes
1. Anal Fissures: These are small tears in the lining of the anus, often caused by passing hard stools. Symptoms typically include sharp pain during and after bowel movements, and you may notice bright red blood on the toilet paper or in the stool. Given that you mentioned your stools are often hard and painful to pass, this could be a likely cause.

2. Hemorrhoids: These are swollen blood vessels in the rectal area that can cause discomfort, itching, and bleeding. The blood from hemorrhoids is usually bright red and may appear on the toilet paper or in the toilet bowl. Hemorrhoids can be internal or external, and they can cause pain, especially during bowel movements.

3. Diet and Hydration: A diet low in fiber can lead to hard stools, which can exacerbate both fissures and hemorrhoids. Insufficient hydration can also contribute to stool hardness.

4. Bowel Habits: Straining during bowel movements or sitting on the toilet for extended periods can increase pressure on the rectal area, leading to or worsening existing conditions.

Remedies and Management
1. Dietary Changes: Increasing your fiber intake is crucial. Aim for a diet rich in fruits, vegetables, whole grains, and legumes. This can help soften your stools and make them easier to pass. Additionally, ensure you are drinking plenty of water throughout the day.

2. Over-the-Counter Treatments:
- Topical Creams: You can use over-the-counter creams or ointments that contain hydrocortisone or witch hazel to reduce inflammation and discomfort. Brands like Preparation H or Tucks Medicated Pads can be helpful.

- Stool Softeners: Products like docusate sodium (Colace) can help soften stools and make bowel movements less painful.

- Fiber Supplements: If you struggle to get enough fiber from food, consider using a fiber supplement like psyllium husk (Metamucil) or methylcellulose (Citrucel).

3. Warm Sitz Baths: Taking warm baths can help soothe the area and promote healing. Sit in a few inches of warm water for about 15-20 minutes, especially after bowel movements.

4. Probiotics: Since you mentioned that probiotics helped soften your stools, it may be beneficial to continue taking them. Probiotics can help maintain a healthy gut flora, which can improve digestion and stool consistency.

5. Avoid Straining: When you feel the urge to go, try not to hold it in. If you find yourself straining, consider using a footstool to elevate your feet while sitting on the toilet, which can help align your body for easier passage of stool.

6. Medications: If your symptoms persist, consider discussing with a pharmacist or healthcare provider about potential oral medications that can help with pain relief or stool softening.

When to Seek Medical Attention
While many cases of anal fissures and hemorrhoids can be managed at home, you should seek medical attention if:
- You experience significant pain that does not improve with home treatments.

- There is a large amount of blood or the bleeding persists.

- You notice changes in your bowel habits or stool consistency that concern you.

Conclusion
Given that you are currently abroad and unable to see a doctor, implementing these lifestyle and dietary changes, along with over-the-counter treatments, may help alleviate your symptoms. However, it's essential to monitor your condition closely. If your symptoms do not improve or worsen, it would be advisable to seek medical attention as soon as you are able. Remember, taking care of your digestive health is crucial, and addressing these issues early can prevent more severe complications in the future.

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