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Dr. Chip
Dr. Chip, Doctor (MD)
Category: Health
Satisfied Customers: 32290
Experience:  Over 20 yrs of Family Practice
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Male, 40. Two weeks ago noticed bright red blood on TP when

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Male, 40. Two weeks ago noticed bright red blood on TP when wiping and had some pain before and after BM (but not a lot of pain). Thought it might be hemorrhoids - got some otc wipes, problem seemed to improve. Now, however, for the last four days I have had extreme difficulty and serious pain when trying to have a BM and have not been able to successfully do so (other than occasional tiny pieces). There is no longer any blood, but a lot of pain when trying to pass stool - and constantly feel like I need to go, but can't pass anything. Burning feeling and anal pain especially before and after trying to go. I have a doc appointment - but not for 10 days. Any suggestions? Do I need urgent care? Not sure what to do.

Is the pain located right at your anus? Any lumps in the area? Have your stools been hard and difficult to pass for some time?

Customer: replied 5 years ago.

Yes the pain is right at the anus, or right inside, but it really only hurts during and after attempting a BM. Though sometimes during the day it will start to burn/tingle a bit. There do not appear to be any lumps that I can detect. The difficulty passing stools has really been only for the last several days. Previously I was able to pass them, although with some pain involved. Now I can't seem to pass any.

OK. There are two possibilities here, and you could have one or both. You may have internal hemorrhoids that you couldn't feel on the outside and now one has become inflamed and bleeding, or you may have developed an anal fissure--a tear in the rim of your anus, and that can be very painful as well as causing bleeding. It's possible you have both. For now, a sitz bath--soaking you butt in warm water for fifteen minutes--and either Preparation H or a cortisone cream applied to the area after applying witch hazel with cotton balls will help with the pain. I'd also suggest some stool softeners to loosen the stool. All that said, if I have a patient with these symptoms, I suggest a sigmoidoscopy to look at the rectum and sigmoid colon just to document the problem and to make sure the bleeding isn't from higher up from a colon polyp
Customer: replied 5 years ago.

The thing that is strange though is that the bleeding was a couple of weeks ago, and there has been no bleeding since then. Initially, there was blood, but not a lot of pain (though some), and no constipation. Now, there is no blood, more serious pain, and an inability to have a real BM and a constant feeling of having to go but not being to get the stool through. Currently my main issue is the pain I feel when trying to pass stool and not being able to really do so. Is it a good idea to continue with prunes and stool softener plus laxative? I don't want to do more harm as I am spending a lot of time on the toilet agonzingly trying to pass stool that won't push through. Does this seem like a reason to go to an urgent care facility at this point? (I should mention I also am a very anxious person generally).

Are you at least able to get some stool through and is it more that the pain makes it difficult to bear down and push more through?
Customer: replied 5 years ago.

I have been able to get some stool through but not a lot. And when I do it is broken up in clumpy pieces. The pain is the big factor in not being able to push more through, but it just literally feels like it can't get through no matter how hard I push.

OK--the reason I said you might have both internal hemorrhoids and now an anal fissure is because the bleeding was painless in the beginning. If the prunes, stool softener and laxative aren't effective by tomorrow, I would suggest you go to urgent care just for an inspection of your anus and a digital exam of the rectum. At that point, they can administer an enema to help clear you out for now.
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Customer: replied 5 years ago.

Thanks for the information and excellent service. Last question - is there anything in particular (besides prunes) I should eat or not eat over the next few days?

Thanks again.

For now I'd stay away from nuts and seedy things. I'd also suggest some mineral oil. Let me know how it goes.
Customer: replied 5 years ago.

I wanted to follow up on the situation. Late last night after much effort I was able to have a bowel movement, but it was in pieces/small clumps and included bits of undigested food (corn, lettuce). I still felt like I had a lot more that I could not push out. This morning - I cannot seem to get anything through at all even though I strongly feel like I need to go and tried for about a half hour. Is there anything more you can suggest at this point?

really you've never had anything like this before just now? Any abdominal pain or cramping?
Customer: replied 5 years ago.

Never had anything like this before. Minor upset stomach but not too bad. Just the pain of not being able to get stool out that is right there but not passing. And the constant feeling of having to go but not being able to. And a little bit of burning/tingling after trying to have the bm and when passing gas. Also tired and sleeping most of the last few days.

Just for a minute--do you have any medical conditions or take any medications?
Customer: replied 5 years ago.

No medical conditions or medications (just otc allergy medication for hay fever occasionally).

OK--so as far as BM's go, just one day suddenly the stool was so hard you couldn't get much out?
Customer: replied 5 years ago.

At first there was just a lot of pain but I could have a BM successfully. That was for about 10 days or so. More recently (3-4 days) I haven't been able to get anything out - and was only able to do so after taking the laxative - and even with that it was a fairly small amount in pieces/clumps.

you've never had the problem with food particles before now?
Customer: replied 5 years ago.

I can't remember if I've ever noticed that before.

Well, of course, with pain with bowel movements there can be a tendency to hold things in and get some very hard stool but with an effective laxative you can't usually fight against that. That said, food particles in the stool imply a malabsorption condition like celiac disorder or pancreatic insufficiency. Irritable bowel syndrome can cause constipation but not also the food particle problem. You need the digital exam and possibly a disimpaction of the stool but you then need colonoscopy and a stool sample study to see what the underlying problem may be.
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