Bowel Issues: When Constipation and Blood Occur

Experiencing the urge to defecate but being unable to do so?

Dear Dr.
Ko,
For the past two to three days, my bowel movements have been unusual.
Initially, I noticed blood in my stool.
I consulted a doctor who prescribed hemorrhoid cream for my anus.
After the first application, there was still blood, but by the second application, the bleeding had stopped.
However, when I feel the urge to have a bowel movement, I find myself in the restroom for a long time before anything comes out.
Sometimes I pass soft stools, and other times, I have a solid mass.
Since my bowel movements became irregular, I haven't had a straight, formed stool.

Now, it has become increasingly strange; I feel the urge to go, but when I do, I can’t seem to pass anything substantial.
In the end, only a small amount of stool comes out, and then I struggle to pass more.
I am very worried.
I have seen doctors who say that my bleeding and changes in bowel habits are due to hemorrhoids.
Why is this happening? I have experienced similar symptoms before, and a doctor diagnosed me with irritable bowel syndrome.

I have scheduled a painless colonoscopy at Kaohsiung Medical University on November 26, and I am genuinely concerned that the doctor might have misdiagnosed me since he only performed a digital rectal exam and did not conduct a thorough colonoscopy.
Could this be a symptom of colon cancer? By the way, I have a bowel movement every day.
I would like to ask the doctor if it is normal to have stool formation the day after eating three meals.

Wang Dashu, 30~39 year old female. Ask Date: 2014/11/01

Dr. Ke Fangxu reply Surgery

The issue with irritable bowel syndrome (IBS) is that its symptoms are very similar to those of colorectal cancer.
If symptoms do not improve after medication, it is appropriate to undergo further colonoscopy.
As long as bowel motility is normal and you have regular meals with daily bowel movements, this is considered normal.
It is recommended that you wait for the colonoscopy.

Reply Date: 2014/11/01

More Info

When it comes to bowel issues, particularly those involving blood in the stool and changes in bowel habits, it is essential to approach the situation with caution and a thorough understanding of the potential underlying causes. Your symptoms, including the presence of blood in your stool, changes in the consistency of your bowel movements, and the feeling of incomplete evacuation, can be concerning and warrant further investigation.

Firstly, the presence of blood in the stool can arise from various sources within the gastrointestinal tract. Common causes include hemorrhoids (piles), anal fissures, diverticular disease, and more serious conditions such as colorectal polyps or cancer. Hemorrhoids are often the most benign explanation, especially if the blood is bright red and appears on the toilet paper or mixed with the stool. They can be exacerbated by straining during bowel movements, which may occur if you are experiencing constipation or irregular bowel habits.

Your description of having soft stools at times and then experiencing difficulty with bowel movements suggests a possible fluctuation between constipation and diarrhea, which can be indicative of irritable bowel syndrome (IBS). IBS is a functional gastrointestinal disorder characterized by symptoms such as abdominal pain, bloating, and changes in bowel habits. It is essential to note that while IBS can cause discomfort and changes in bowel habits, it typically does not cause blood in the stool. Therefore, the presence of blood should prompt further evaluation to rule out other conditions.

The fact that you have already consulted with a physician and received treatment for hemorrhoids is a positive step. However, if you continue to experience blood in your stool or if your symptoms worsen, it is crucial to follow up with your healthcare provider. A colonoscopy, which you have scheduled, is an important diagnostic tool that allows for direct visualization of the colon and rectum. It can help identify any abnormalities, such as polyps or lesions, that may require further intervention.

Regarding your concern about colorectal cancer, it is understandable to feel anxious, especially when experiencing symptoms that deviate from your normal bowel habits. While colorectal cancer can present with changes in bowel habits and blood in the stool, it is more common in individuals over the age of 50 or those with a family history of the disease. Nevertheless, early detection through screening is vital, and your upcoming colonoscopy will provide clarity.

In the meantime, there are several strategies you can implement to help manage your symptoms and promote regular bowel movements:
1. Dietary Changes: Incorporate a high-fiber diet that includes fruits, vegetables, whole grains, and legumes. Fiber helps to bulk up the stool and can alleviate constipation.

2. Hydration: Ensure you are drinking plenty of water throughout the day. Adequate hydration is essential for maintaining healthy bowel function.

3. Regular Exercise: Physical activity can stimulate bowel movements and help reduce feelings of bloating and discomfort.

4. Avoid Straining: When you feel the urge to have a bowel movement, try to respond promptly to avoid straining, which can exacerbate hemorrhoids.

5. Medication: If you are prescribed medications for hemorrhoids or other gastrointestinal issues, be sure to follow your doctor's instructions carefully. Over-the-counter options, such as stool softeners, may also be beneficial.

6. Monitor Symptoms: Keep a diary of your bowel habits, dietary intake, and any symptoms you experience. This information can be valuable for your healthcare provider in determining the best course of action.

In conclusion, while your symptoms may be concerning, they are not uncommon and can often be managed effectively with appropriate medical care and lifestyle modifications. It is essential to maintain open communication with your healthcare provider and to follow through with the recommended diagnostic procedures to ensure your health and peace of mind.

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