Bowel Irregularities: Causes and When to Seek Help - Gastroenterology and Hepatology

Constipation

Hello Dr.
Chen: I usually have a regular bowel movement every evening.
I work a 9-to-5 office job.
Over the past three months, my bowel movements have remained normal, but I frequently experience the following issues: the first stool is of normal shape and consistency, but subsequent stools require straining to pass and are soft, unformed, or in pieces.
I have to wipe multiple times to feel clean, and I experience itching and a slight foreign body sensation in the anal area.
Occasionally, I notice a small amount of bright red blood on the toilet paper (possibly due to excessive wiping?).
Could this situation be caused by food-related soft stools? Should I consider further examination? Thank you.

Liu Xiansheng, 20~29 year old female. Ask Date: 2015/06/11

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello, it is recommended to eat more fruits and vegetables, and to reduce oil, dairy, and刺激 foods.
If soft stools do not improve, please consult a gastroenterologist.
As for the blood in the stool, it is likely caused by hemorrhoids.
If it persists or worsens, please seek medical attention from a colorectal surgeon.
Wishing you safety and health.
Sincerely, Dr.
Chi-Feng Chen, Attending Physician, Department of Gastroenterology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2015/06/11

More Info

Understanding bowel irregularities can be quite complex, as they can stem from a variety of causes, ranging from dietary habits to underlying medical conditions. In your case, the symptoms you've described—normal bowel movements followed by soft, unformed stools, anal itching, a sensation of foreign body presence, and occasional blood on the toilet paper—warrant a closer examination.

Firstly, let's address the potential causes of your symptoms. Dietary factors are often the first culprits to consider. A diet low in fiber can lead to irregular bowel habits, including constipation and the formation of hard stools, which may cause straining during bowel movements. Conversely, a sudden increase in fiber intake, or the consumption of certain foods (like dairy, fatty foods, or artificial sweeteners), can lead to softer stools. It’s also important to consider hydration levels, as inadequate fluid intake can affect stool consistency.

Another possibility is the presence of hemorrhoids, which can cause anal itching and bleeding, especially after straining during bowel movements. Hemorrhoids are swollen veins in the lower rectum or anus and can be exacerbated by constipation or prolonged sitting. The sensation of a foreign body could also be related to hemorrhoids or anal fissures, which are small tears in the lining of the anus that can occur due to hard stools.

In addition to dietary and hemorrhoidal issues, your symptoms could indicate a more serious condition, such as inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis. These conditions can cause changes in bowel habits, abdominal pain, and rectal bleeding. Other potential causes include infections, irritable bowel syndrome (IBS), or even colorectal polyps or cancer, particularly if you have a family history of such conditions.

Given the presence of blood on the toilet paper and the discomfort you’re experiencing, it is advisable to seek medical attention. A healthcare provider may recommend a thorough evaluation, which could include a physical examination, a review of your medical history, and possibly diagnostic tests such as a colonoscopy or stool tests. These tests can help rule out serious conditions and provide a clearer picture of your gastrointestinal health.

In summary, while your symptoms may be related to dietary factors or benign conditions like hemorrhoids, the presence of blood and discomfort necessitates further investigation. It’s essential to consult with a healthcare professional who can provide a comprehensive assessment and guide you toward appropriate treatment options. Early intervention can often lead to better outcomes, especially if there are underlying issues that need to be addressed.

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