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Dr. Tharun
Dr. Tharun, Doctor
Category: Health
Satisfied Customers: 3682
Experience:  MBBS
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Having difficulty pushing stool out and stool is soft! After

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Having difficulty pushing stool out and stool is soft! After much straining and grunting, it comes out though not all once. Also develop a tear/fissure in the process. How can this condition be treated?

Dr. Tharun :


Dr. Tharun :

Does it pain when the stools come out?

Customer: yes
Dr. Tharun :

Have you tried the taking fibre and dulcolax

Customer: Yes
Dr. Tharun :

Does that help ?

Customer: Fibre, yes. Not sure about the dulcolax
Dr. Tharun :

So taking fiber relieves the trouble.

Customer: Makes stool soft, but not the difficulty in pushing initial stool out. Once first bit comes out, the remainder follows with relative ease
Dr. Tharun :

Some people have slow bowel which makes the stools harder to come out.In these cases taking fiber, laxatives and bowel motility drugs will improve the stool transit.

Dr. Tharun :

Are you taking anything for the fissure?

Dr. Tharun :

Have you seen a surgeon for the fissure?

Customer: Never used to have this problem until I had a colonoscopy done recently. Had colonoscopy to investigate frequent pile problems. Use anusol et al for the fissures. Haven't seen a surgeon.
Dr. Tharun :

Fissure can sometimes narrow the opening of the anal canal and this difficulty can appear, where the you have difficulty pushing out soft stool too. Dilatation of the anal canal is the treatment in such cases.

Dr. Tharun :

A surgeon can do a rectal exam and decide whether the anal opening is normal or not.

Dr. Tharun :

Have you under gone any previous surgeries in the abdomen?

Customer: No previous surgery in the abdomen. Any possible link with the colonoscopy? By the way, what is a fissure? I assume it means a tear.
Dr. Tharun :

Yes it means a fissure in the wall of the anal canal which makes passing stools painful.

Dr. Tharun :

So people try to avoid pushing enough which results in constipation and the cycle continues.

Dr. Tharun :

Colonoscopy can dilate the bowels as air is pushed during the procedure.

Dr. Tharun :

This may cause some temporary trouble but long term complications are rare. Fibers and laxatives will take care of the problem.

Dr. Tharun :

Consult a surgeon if you have pain while passing stools, because this is an indication of active fissure in the anal canal.

Customer: but must one depend on laxatives forever or will need abate over time? Which laxative is recommended?
Dr. Tharun :

Bulk forming fibers are good. Stool softeners are also good.

Customer: Main problem is not the pain but the difficulty getting it out. Pushing hard but not coming through
Customer: And stool is soft when it eventually comes.
Dr. Tharun :

The opening may be compromised in that case because of the fissure. Also the anal sphincter muscle is usually in a spasm which makes it even more harder for the stools to come out.

Dr. Tharun :

Taking care of the fissure should take care of this trouble too.

Customer: I believe the fissure is a secondary matter and not the primary issue. Fissure occurs as a result of the forceful push. Need to address what triggers the need to strain/force.
Dr. Tharun :

When was the colonoscopy done ?

Customer: About 6 weeks ago
Dr. Tharun :

And the problem started after the colonoscopy ?

Customer: And some 'banding' was done at the time. Yes, problem started after the colonoscopy
Dr. Tharun :

Has the band fallen off.

Customer: Don't know.
Dr. Tharun :

Banding involves pulling a pile into a rubber band and cutting its blood supply off. The banded pile slows dies and is sloughed away.

Dr. Tharun :

This may cause some block in the passage of stools due to the banded pile.

Dr. Tharun :

But this happens in a week or two. So for this problem to persist after 6 weeks is little rare.
Another possibility is that the bowels can become a little roomy due to the air insufflation during colonoscopy. Roomy bowels may require more power to contract and push the stools.

Customer: Sounds plausible. What can be done about it?
Dr. Tharun :

The bowels will recover to its pre-colonscopy state in some time. Till that time support it with fiber diet and supplements. Take care of the fissure if you think it is still present by seeing a surgeon. Exercises and aerobics will help increase the abdominal tone.

Customer: Thanks.
Dr. Tharun :


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