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Having difficulty in passing bowel movement and noticed blood in it. Not cured by pilex. Concerned

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Practicing since : 1962
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I am having problem passing stool. It has all started after a painful passing of very hard stool almost 3 weeks ago. After that It is getting worse. I have applied Pilex for last three days but it is not giving any relief.
Now a days heave thick blood also comes out during bowel movement.
I also have GERD and I am on PPI (sometimes H2 blocker) for last 2.5 years.
Posted Thu, 1 Nov 2012 in Digestion and Bowels
Answered by Dr. Charles S Narasi 32 minutes later
IBS and constipation problem can lead to problems such
as Hemorrhoids (Piles) like you are experiencing. This
could get irritated and bleed during straining.
The key to preventing constipation is adequate intake
of fiber and fluids. Too much fiber is also bad, that could
add to too much bulk and hence hard stool.
Fresh fruits and vegetables alnog with 4-6 glasses of water
daily is very helpful. Since you have hard stools, you may
benefit by taking some stool sotener such as Doxidan (Bisacodyl)
available over the counter. If you take that before you go to bed,
you will have a softer stool in the morning. If you are not
getting enough fiber, you may need Methyl cellulose powder
supplements, 1-2 tablespoons a day with a full glass of water.
As for Hemorrhoids, sitting in a hot tub (Sitz Bath) for 15-20 mins,
two or three times a day will be helpful. Also, there are creams
containing 5-10% Hydrocortisone with some local anesthetic you
can apply over the rectal area daily after a bowel movement
helps reduce the swelling and irritation from the piles.
Also, there is ployethylene glycol solution (PEG) available
over the counter. You can start taking it daily 3-4 tablespoons.
Once you start having lose stools, you can cut back on the amount.
As for the GERD, the timing of taking PPI is very important.
They work better if you take it one hour before meals (Big meal
of the day). Eventhough all PPI's are superior to H-2 Blockers, one brand
of PPI might work better in one person than the other.
Make sure you are following dietary instructions as well. Cutting
back on caffeine,citrus ,tomato based products, cheeses etc. is
very important. Avoid eating too late at night and stay up for
at least an hour to two before you go to bed after meals.
Hope all these suggestions will be helpful to you.
Wish you well.
Above answer was peer-reviewed by
Follow-up: Having difficulty in passing bowel movement and noticed blood in it. Not cured by pilex. Concerned 3 hours later
I drink more than 4 liters of water everyday. I finish at-least 2 bottles of water during the night when I am on bed and 2-3 bottles during day time, I am not counting those water that I take before tea, after lunch, etc. So increase of fluid is not at all an option for me. I take at-least one fruit daily after lunch; do I need to increase fruit intake? Any specific fruit you would recommend? Please give me the exact names of the medicines you have prescribed. Today I have taken Lactuose in the morning and in the evening after dinner. Can I also take Doxidan?

I take PPI in the morning almost 1 hour before breakfast. I have tried almost all PPIs, Rabeprazole, Omeprazole, Pantaprazole, and Esomeprazole. These days (for around a month) I am on Raciper (Esomeprazole 20mg) and I think it is working better than other PPIs but still for last few days I need to take two 20mg PPI daily.

Is there any long term adverse effect of GERD? What about long term side effect of PPI? I have heard it causes fragile bone. Should I take Calcium supplement, will that help? Should I also take multi-vitamins because PPI can also cause B12 deficiency? What is the right time to take multi-vitamins? Is it safe to take Lafutidine for a long term, since I switch to Lafutidine when PPI becomes less effective?

My weight was 83 kg when GERD was first diagnosed and then my weight went to 95 kg in a duration of 2 years and problem became worse from bad. I have now come back to 83 kg. I am 5'9", 35 years old Indian male. Should I reduce my weight further?

Also, I have taken almost all well known precautions like giving up smoking, reduced alcohol intake significantly, gave up coffee, chocolate, citrus fruit, etc etc. I had a hope that these measures will improve quality of my life but I still face problem once in a while. If I take 20mg PPI daily in the morning then barring few days (4-5 days) of a month I feel OK. Do you think I should be on PPI as long as possible or I should go for fundoplication as my doc has suggested? What is the risk involved with surgery? What are the risks involved if I do not go for surgery?

Answered by Dr. Charles S Narasi 1 hour later
I see that your fluid intake is more than adequate.
Two to three helping of fruits daily is preferable.
Bananas, apples, peaches.pears and grapes, papaya,
would be fine.
You are asking about the long term effects of GERD.
If GERD is not treated properly, it leads to scarring or
stricture causing narrowing of the esphagus. Ulcers of
the esophagus can bleed. The worst complication or
the most serious one is development of Barrett's
esophagus which is pre-cancerous. The lining of
the lower esphagus changes and abnormal cells
make up the lining making it turn into cancer cells.
Longer the duration of GERD and longer it goes
untreated, this possibility increases.
If you are getting good relief from Esomeprazole, I
would stay with it. PPI's are essentially safe and we
have had the longest experience with Prilosec (Omeprazole).
There have been no reported cases of cancer of the stomach
taking this for years. The only concern is about keeping the
acidity too low in the stomach which may cause some
bacteria to grow. It can cause infections like Pneumonia.
This is very rare in practice.
As for Doxidan , you can take it once a day. There are
similar products available and your drug store ,pharmacist,
can guide you about this. Lactulose is also effective, but if
you have lactose intolerance, this could give you lot of gas.
I think your weight is O.K.
Fundoplication should be the last resort. If your life is of poor
quality due to GERD, then you can go for surgery.
It can be done through laparoscopic approach by competent
surgeons. Before you have this , find out how many of this
type of surgery he or she has done.
There are complications such as inability to swallow or belch
or burpe. It might require stretching after the surgery.
Complications related to anesthesia ,bleeding, infection
and even possibility of reactions to sedatives etc. can occur.
Every surgery carries risks and your surgeon has to be honest
in discussing all these and the alternatives.
Hope I have given enough information for you to discuss this
with your gastroenterologist and your family doctor as well.
Wish you the very best Satyanrajandas.
Above answer was peer-reviewed by
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