Bowel Movement Issues

[cyu]

Hi,
I’m a 24 year old male. Over the past few days, I developed some symptoms relating to my bowel movements. In general, my bowel movements have been rather loose. Also, they tend to produce smaller stools (1 cm diameter). These bowel movements typically occur about an hour or so after I wake up. Afterwards, I no longer feel the need for another movement until early afternoon, where I’ll start feeling the need to have a bowel movement originating in my rectum (not abdomen). I have a bit of flatulence but no bloating/discomfort. When I try to have a BM, I only produce a small amount (though hard stools this time). I have no trouble with it while sleeping.

Also, starting around mid-afternoon, I feel slight irritation right at the anal area (perhaps 2-3 cm into the anus). The feeling is related to the slight need to have a bowel movement. I performed a digital exam myself. The inside of my anus felt irritated and slightly painful, and I felt a small (pea-size), fairly hard lump about 2-3 cm on the mucosa. The lump was slightly painful to the touch. I suspected this was the cause of the irritation (along with possible residual stool) as I did not find anything else immediately alarming (though of course I do not have the training to know what should induce alarm). Finally, my anal sphincter feels slightly harder or more “swollen” than usual to the touch (it appears normal visually).

Some background: I’m also currently fighting something akin to a summer cold (chest congestion, green mucus coughed up, etc.). In the past few weeks, I did some very extensive air travel, which likely weakened my immune system. I have had some trouble with what I think were hemorrhoids a few years back, and I have on occasion masturbated anally.

My main concern is whether these symptoms indicate an internal hemorrhoid or something else. Specifically, I’m wondering if I could have the beginnings of a partial prolapse (from the masturbation or otherwise) or IBS. Thank you.

[Dr. Kokil Mathur]

Hi!

I can understand your concerns and agree with your line of thinking.

Since you have a past history of hemorrhoids, yes, an internal hemorrhoid is a possibility. If the mass is above the internal anal sphincter it is an internal hemorrhoid. You have many symptoms that are commonly seen in internal hemorrhoids. They can become painful when inflamed or infected. It is not visible externally nor can be felt at the anal opening until it partially or fully prolapses. The internal hemorrhoid causes a feeling of itch or irritation just inside the anus and a feeling of incomplete evacuation (the feeling of need to pass a stool that originates somewhere inside the anus).  Prolonged travelling, sedentary life style, decreased roughage in diet, constipation etc all predispose towards a hemorrhoid formation. You have all these factors which favor a diagnosis of internal hemorrhoid.

The only point that goes against this diagnosis is that usually internal hemorrhoids cause bright red blood to fall after passing stool. Also, usually the patient does not suffer from loose stool.

You can take non-steroidal anti-inflammatory pain killers, diet rich in fibers, plenty of water and sit in a tub of warm water for 15-20 minutes, twice a day (sitz bath). You can apply creams available for hemorrhoids which contain a combination of an analgesic (lignocaine), a vasoconstrictor, zinc oxide and petroleum jelly.


The other possibility as you said is IBD (irritable bowel disease). The IBD spectrum of diseases includes Ulcerative colitis, Crohn’s, Celiac, and IBS (irritable bowel syndrome).
This also causes anal itch and a feeling of incomplete evacuation. The individual may have loose stool, constipation or loose stool alternating with constipation. Blood is present in microscopic amount in stool and is not visible to naked eye. Hence occult blood test is done on a stool sample.

Treatment of IBS: Keep a stress diary. Log in the food intake and the symptoms as they appear. See if there is a correlation between a particular food item and symptoms. Add fiber to your diet through consuming bran, whole grains, fruits and vegetables. Add crushed psyllium seed to your food preparations. Also, add fibers slowly as adding fibers too fast can cause bloating and gas. Also, add water in any form to your diet—plain water, lemonade, clear soups,etc. Fiber supplements can also be added. You need to go slow on food that increases gas content of the gut such as salads, raw fruits and vegetables (especially cabbage, broccoli and cauliflower), and carbonated beverages. Medications can be prescribed such as anti-diarrhea medications, anticholinergic medications, anti-depressants and medications to loosen the stool if there is constipation. Eat small frequent meals. Exercise regularly as these help the bowel to move.

Other possibilities: Apart from this your symptoms can be due to parasitic infections and a stool test should be done. In this case the lump inside the anus could be injured mucosa (during masturbation). I am thinking of parasitic infestations considering the fact that you are travelling a lot. The lump could also be a benign rectal tumor, a rectal polyp, a rectal abscess, genital wart or a hematoma.

What your doctor can do for diagnosis: Your doctor can diagnose the lump by clinical examination of the anal opening or by proctoscopy (inserting a proctoscope, an instrument to visualize the anal mucosa better). If your doctor feels it is IBD, then you may need specialized tests like endoscopy, colonoscopy, celiac test etc to diagnose the type of IBD. Please discuss with your doctor.

I sincerely hope you will find this information useful. Hope you get well soon! Good Luck and take care!

[Dr. Kokil Mathur]

Your symptoms sound less like a rectal prolapse. And yes, if you strain as in passing stool the rectal mucosa bulges out. In rectal prolapse the protruding mucosa is higher up than the position of a hemorrhoid, is a larger swelling which is prominent on straining. It will not be a pea size swelling. When you strain you will be able to feel a mass protruding out and not a generalized protrusion of the mucosa of rectum. Hope this clears your doubt.
However, nothing can be confirmed without clinical examination.

[cyu]

Thanks very much! The information was very useful. I noticed that you did not really address the potential issue of rectal prolapse: is this not an issue? The reason I ask is because I was (and still am) somewhat worried particularly about prolapse. For the past couple of days, usually right after I eat dinner, I’ve felt a slight “pressure” or tension beneath the area of the internal oblique muscle (that extends down to about a couple of inches above the penis). The “tension” was slightly noticeable while sitting, and was a bit more noticeable while standing. It also caused a slight discomfort in the area behind the immediate tension, which I assumed was the bowel (and beginnings of the rectum). Could this be the interior of my rectum prolapsing slowly? The cold I mentioned earlier has had me coughing up a storm for some parts of the day, so could that be an alternate explanation?

Finally, when I performed the digital exam mentioned earlier, I contracted my diaphragm, mimicking a BM, and felt the walls of my rectum (above the anus) swell outward a bit. This may seem stupid, but is that normal? I assume yes, since I’m guessing that’s how the contents of the rectum are pushed out, but I just want to be sure. Otherwise, I did not feel any loose mucosa, and the only observation I had was that the inside of the rectum seemed inflamed/swollen (though again, I’m not exactly qualified to make that observation). All in all, I’m not sure whether I’m just imagining symptoms or if I really should be concerned about early stage prolapse.