Constipation and Hemorrhoids
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After food leaves the stomach, it enters the small intestine, the beginning of the lower gastrointestinal (GI) tract. As it passes through, the major portion of digestion and absorption takes place. Undigested food residue, debris, and some water then pass into the large intestine, or colon, where almost all of the water absorbed, and the solids are compacted as feces. This fecal mass is stored until distention causes a reflex muscle movement that propels the mass into the rectum for defecation and excretion through the anus. Normally, ingested food passes through this system and its waste products are excreted within 35 - 70 hours, resulting in a normal bowel movement 3-12X/week. However, the defecation reflex is rather weak, and easy to ignore. We ignore the reflex for many reasons, including inconvenience or lack of private, clean, or comfortable bathroom facilities. After a few minutes, the reflex goes away, and will not begin again for several hours. During this time, the fecal mass becomes drier and harder, resulting in constipation. |
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Constipation
Constipation describes bowel movements that involve excessive straining, difficulty, or discomfort; or that occur less than twice a week. Although occasional constipation is common, chronic or persistent constipation and associated straining at bowel movements can lead to more serious problems. Complications of chronic constipation may include hemorrhoids, anal fissures, and damage to the muscles and supportive tissues of the anus and perineum. The most common cause of constipation is a diet lacking fluid and fiber, in combination with poor bowel habits, such as routinely delaying defecation. Other causes of constipation may include:
- Medications (antidepressants, narcotics, antacids, iron supplements, and others)
- Pregnancy
- Prolonged inactivity or bed rest
- Acute illnesses, and
- Chronic conditions such as diabetes, hypothyroidism, and neurological or connective tissue diseases.
Hemorrhoids
Hemorrhoids, or enlarged hemorrhoidal veins, may be internal or external. Internal hemorrhoids are located in the rectum. They may not cause pain initially. Symptoms may include bright red blood coating stools in the toilet, or on the toilet tissue after wiping.
If a clot forms in the vein, or if it becomes infected or injured, pain may be severe. Over time, internal hemorrhoids may become large enough to protrude through the anus, appearing as reddish, moist masses, and can result in chronic fecal leakage and soiling.
External hemorrhoids appear as very tender, sometimes itchy, bluish swellings at the anus. They frequently cause bleeding and anal spasms, making defecation painful, and causing further constipation.
Anal fissures are small, superficial, painful cracks in the lining of the anal canal, often caused by the passage of hard, irregularly shaped stools. They can cause spasms and painful defecation.
Preventing and Treating Constipation
Pay attention to the urge to move your bowels. It usually occurs shortly after eating a meal or following exercise. Let nature take its course.
Drink adequate amounts of fluids; eight to ten glasses of water or juices a day.
Increase the amount of high fiber foods in your diet. Consider those listed below:
- Green, leafy vegetables (cabbage, spinach, celery)
- Whole and dried fruits
- Whole grain, high fiber breads and cereals (e.g., Fiber-all, All Bran, Raisin Bran). Read labels carefully; aim for 10-20grams of fiber per day.
- Beans, nuts, seeds, and sprouts
Note: Increased dietary or supplemental fiber can result in bloating and gaseous distention. Change your eating habits gradually.
Exercise regularly. Walk, jog, bicycle, or participate in a sport.
Preventing and Treating Hemorrhoids and Anal Fissures
- To prevent hemorrhoids, avoid constipation, excessive straining at bowel movements, and prolonged sitting on the toilet.
- Usually, hemorrhoids can be treated with conservative, non-surgical therapy. Confirm with your health care provider that hemorrhoids cause your symptoms, and that non-surgical treatment is recommended.
- Follow all of the recommendations listed above for preventing and treating constipation. Sometimes fiber supplements (Citrucel, Metamucil, Fibercon, Fiber Choice and others) or stool softeners (Colace) are recommended. Soft, bulky stools are less painful and easier to pass.
- Ointments and suppositories, like Preparation H and Anusol, lubricate the anus, and protect the mucosa. A well-lubricated finger can be used to gently push the hemorrhoid back into the anal canal.
- Sitz baths, in which you sit in a warm bath (or Sitz bath basin you can purchase at a pharmacy) for 15-20 minutes several times a day, provide comfort and speed resolution.
- Keep the area clean and dry. After using the toilet, cleanse with wet towelette, such as TUCKS. Some students blow dry the area gently with a hair dryer.
Following these guidelines will help anal fissures and may prevent constipation by forming soft, bulky stools.
- Sitz baths can also be used for anal fissures. The area should be kept clean and dry. Ointments, such as petroleum jelly (Vaseline) or Preparation H applied with a well-lubricated finger will protect the mucosa while it heals. Symptoms should resolve in 3-5 days.
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WARNING! Signs and symptoms that indicate a need for evaluation by a health care professional include:
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