What is the treatment for blockage during bowel movement?

Question

Hi doctor,

I started the contraceptive pill Yasminelle almost two years ago—sometime after that, my bowel habits changed slightly. I began experiencing diarrhea more often than I would have before. This has stopped and started over the last two years. There have also been small amounts of blood on the tissue, never much, and it has only occurred a few times. However, I have been constipated. I have taken Dulcolax, which was not of many benefits. I also took an enema which did work slightly. However, it still feels like there is a blockage preventing me from emptying my bowels. I had normal blood tests done recently, apart from vitamin B12 deficiency, which is now being treated with injections. Please help.

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

I have reviewed your attached report (attachments removed to protect the patient's identity). So, there is a change in bowel habits, so it is essential to mention a few points like bleeding amount, fresh red bleeding, and painless or painful bleeding.

1. Is there any lump or swollen area at the anal verge?

2. Is there any associated history of unintentional weight loss?

3. Any family history of prolonged constipation or ulcerative colitis, or any cancer?

4. Have you not noticed white or yellow mucus mixed with stools most of the time?

You have noticed this change in bowel habits started after the contraceptive pill. Still, there are no significant known side effects of Yasminelle (Ethinylestradiol and Drospirenone), such that it can cause constipation or diarrhea, but yes, bloating and nausea can occur. Other possible reasons are sensitive gut, which can usually cause a change in bowel habits, associated with stress or anxiety and more common in your age group. One more differential diagnosis is dysbiosis or sub-acute intestinal infections if you frequently eat out or eat junk food. It is great that your workup was negative, vitamin B12 deficiency would not explain this and be already corrected.

My suggestions would be:

Take regular probiotics, either yogurt daily or commercially available probiotics, for two to four weeks. This will replace harmful bacteria with good healthy bacteria within your gut .
Add plenty of water and a high-fiber diet, including psyllium husk. If your constipation persists, add a polyethylene glycol sachet. You should be passing stools once daily, at least. In case of diarrhea, you can readjust the dose accordingly.
In case of persistent diarrhea, get your stool detailed report to see if there is any infection. If yes, it will be treated accordingly.
Look for clinical history features which I have mentioned in point number one above; if all of the above is negative, such as no family history, weight loss, lump, mucus, etc. so, significant red flags signs would be absent. There would be nothing to worry much about.
Last, if you still feel that particular contraception induced these gut disturbances, you can stop and switch to other contraception methods for a while to recheck.

I hope this information will help.

Thanks.

Answer 2

Hi,

Welcome back to icliniq.com.

I understand your concern.

This is less likely to be an anal fissure for painless bleeding, and internal hemorrhoids can be possible. For both of the above issues, the primary treatment is to avoid constipation, and you should not be straining while passing stools. An excessive amount of mucus comes in infections sometimes, your blood workup was normal, as you mentioned. If you feel more mucus, get your stool detailed report to see if there is any element of infection. Rest continue with the same plan as advised before.

I hope the information will help.

Thanks.