How to manage bowel movement problems?
Q: I have been suffering from severe problem in bowel movement. Constipation, though my stool is not hard but thin, diarrhoea, profuse mucus discharge (sometimes bloody i.e. pink in colour) with stool even almost with every motion of urine, sometimes with release of gas, mucus comes out, sometimes I notice little blood in toilet paper. I have to apply a lot of pressure to start motion. I have to strain so much during motion that I tend to have abdominal pain, severe headache even black-outs. But even with the straining the stool does not come out. I have to put my fingers into the rectum to clear stool, without putting fingers it can't be empty. There is a feeling of something coming out from the rectal passage. Presently I am unable to bear the pain, can't travel for a long time, unable to sit for a long time. My appetite has also decreased and I am feeling very week. I consulted a gastroenterologist here. He has performed a colonoscopy last week, and has detected multiple ulcers, internal haemorrhoids and polyps. The polyp has been found to be adenomatous. Though the size of the polyp is not mentioned in the report, I had asked the doctor and he mentioned it as 3-4 mm. The reports of colonoscopy and histopathology are mentioned below. The polyp has not been removed during colonoscopy. The doctor here is of the opinion that the polyp has to be removed anyway, but ulcer has to be healed by applying Sucralfate enema, before something can be done about the polyp. Endoscopy findings: 3 columns of internal haemorrhoids; rectum with multiple ulcers suggestive of solitary rectal ulcers; Polyp of 3-4 mm size; rest of mucosa upto caecum was normal Histopathology report: Diagnosis - Benign Adenomatous Polyp; Microscopic finding - Sections show features consistent with benign adenomatous polyp. Diagnosis - Solitary Rectal Ulcer; Microscopic findings - Sections show distorted rectal glands, mild to modest inflammatory response and splaying of muscularis mucosa below. No evidence of malignancy found in the section. I would like mention once again that this rectal pain and other problems has recently become unbearable though I have managed for quite a long time. I am a working woman and missing my duties for the same. Could you please give me some advice?
A:This condition is called as solitary rectal ulcer syndrome and is caused by prolapse of rectal mucosa (bulging out of wall of rectal mucosa, causing lack of blood supply). Polyp is not much of a issue and can be taken out later (1 year or so). Treatment is avoidance of constipation by eating high fibre diet, lactulose or other laxatives. You did not mention what country you live in, in USA a new medicine to treat constipation is available, but first others need to be tried. Last option is surgical, called rectopexy and is successful in 50-60% of the patients. Biofeedback is an option. All this depends on your age / how many children were delivered vaginally, and what medical facilities are available around you.