I have constipation with rectal bleeding. How to treat it?

Question

Hi doctor,

I am a 25-year-old female, 50 to 52 pounds in weight, and 6 feet 4 inches in height. I have been suffering from constipation. I would have pooped for only two days in the past three weeks. Last week, my rectum was bleeding as I was trying to push the poop out. It was a bright red color.

Whenever I try to poop, it will bleed. I have not pooped for the past five to six days because it hurts to push out. And after that, I have pain in my leg muscles. What to do, doctor?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Well, the bleeding can be explained by hard stools and chronic constipation, which can be due to any one of the three things. Hemorrhoids, anal fissure, or ulceration of the rectum due to the force of hard stools, and the condition is called Stercoral ulcers.

Since the bleeding is a secondary phenomenon, the aim is to treat underlying constipation. Now, in your age, there are common conditions that can cause chronic constipation symptoms, namely pelvic floor dyssynergia, which is an uncoordinated relaxation of the muscles over the bottom, which is supposed to relax when attempting to pass stools, Hirschsprung's disease, and idiopathic constipation.

For now, I suggest you follow the regimen below for a week and get back to me to update the symptoms.

Take plenty of water, approximately two to three liters a day.
Increase fiber intake in vegetables and fruits, or take Fibrocol (a natural fiber), two tablespoons full of water.
Take tablet Tranexamic acid 500 mg (antifibrinolytic) thrice daily for three days till bleeding stops.
Polyethylene glycol 17 gm (stool softener) sachet, one sachet twice daily for one week and whenever there is severe constipation.
Do pelvic exercises. On the internet, you can see various pelvic exercises that are easy to perform at home.
If you feel pain while pooping or a burning sensation just after passing stools, then use Xylocaine 2 % gel (Lidocaine) four times daily for a week. Please do sit in the bathtub by filling it with semi-warm water for at least five minutes, two to three times daily for a week.
You are underweight, which is a concern for me. Let me know whether you have episodes of excessive starving or overeating.

I want to know if you have had some blood testing, such as CBC (complete blood count), TSH (thyroid-stimulating hormone), T4 (thyroxin), tissue transglutaminase antibody, IgA, and IgG, done? If yes, upload and, if not, kindly get them done.

Please follow up after the tests and one week after the use of the medications.

I hope this helps.

Thank you.