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Suggest treatment for constipation

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Posted on Sat, 8 Jul 2017
Question: Hi Dr... I am 34 yr old female. I weigh 70 kgs and my height is 5'8". I have constipation issues which at times lead to fissure. I first encountered fissure experience in 2013 and since then it has been happening every year. But this time it has prolonged for a

Little longer time. This time even the skin from the anus has come out slightly. It's right in the centre and blocking the anus passage. I have been eating fibrous food more. Still passing stool in the morning is a problem. There is no bleeding noticed so far in the stool. But I feel a cutting pain when the stool is moving down in the passage just at the anus opening. I feel scared. I have been applying pilorute ointment whenever this fissure problem occurs. I also took some hot water compression today. But the problem doesn't seem to go. Please help. I am terribly scared of any surgery.
doctor
Answered by Dr. Ramesh Kumar (1 hour later)
Brief Answer:
Most likely the mass is hemorrhoid.

Detailed Answer:
Hello Patient,
Thank you for asking your query on HealthcareMagic.
I am a Gastroenterologist and would be answering your query.
Have gone through your details and i appreciate your concerns.
As per your query answers are-
Most luikely its hemorrhoid and not just fissure.Hemorrhoids are swollen veins in the lowest part of your rectum and anus. Sometimes the walls of these blood vessels stretch so thin that the veins bulge and get irritated,

According to standard texts Hemorrhoids are classified as-
Grade 1:hemorrhoid bulges into the canal but does not prolapse or fall completely into it. These may bleed.
Grade 2: hemorrhoid protrudes past the anal verge with straining for a bowel movement or passage of flatus, but spontaneously return to their original internal position once the straining has subsided.
Grade 3: the hemorrhoid may protrude past the anal verge without any straining and requires the patient to push them inside manually.
Grade 4: the internal hemorrhoid always stays protruded or prolapsed and is at risk for thrombosis or strangulation should the anal muscles go into spasm.
Your case is grade 4 hemorrhoid.
So most likely in your case the hemorrhoid has progressed to Grade four now therefore it is non reducible.

Initially we start with conservative management for at least 3 months-
Suggestion for conservative management are-

Start taking Syp. Lactulose 10-15ml once daily before going to bed. It is one of the most frequently used laxatives, tolerated very well by patients in long terms with minimal side effects. Using laxative would prevent straining while defecating.

-Secondly, start using Prepration H (a combination containing contains Calcium Dobesilate, Hydrocortisone, Lignocaine, and Zinc.) locally over the prolapsed mass.

Thirdly, request your gastroenterologist to prescribe you with oral Calcium Dobesilate-Doxium therapy for 3 months. Initially twice daily for 21 days followed by once daily for 10 weeks. Trials have shown that 3-month therapy can cause shrinkage of Hemorrhoids in almost 60% cases.It was demonstrated that calcium dobesilate decreased capillary permeability, inhibited platelet aggregation and improved blood viscosity; thus resulting in reduction of tissue edema.
If not relieved in 3 months we have to plan for minimal invasive or surgical procedure like-
1)Rubber band ligation is a procedure in which the hemorrhoid is tied off at its base with rubber bands, cutting off the blood flow to the hemorrhoid. very effective with high success rate.

2sclerotherapy -In this procedure, a chemical solution is injected into the hemorrhoid tissue to shrink it may be less effective than rubber band ligation.


Surgical procedures-
Hemorrhoidectmy it removes excessive tissue.
Hemorrhoidectomy is the most effective and complete way to treat hemorrhoids.

Hemorrhoid stapling. This procedure, called stapled hemorrhoidectomy or stapled hemorrhoidopexy, blocks blood flow to hemorrhoidal tissue. It is typically used only for internal hemorrhoids.

Meet you Gastroenterologist or general surgeon and discuss the options with him/her.

Please attach a high defination clear picture of the mass if possible.

Some general suggestions are-

-Linseed: is extremely useful in difficult cases of constipation. One teaspoon of linseed with warm water should be taken at night for bulk and lubrication.
-Proper chewing: The diet alone is not enough. Food should be properly chewed-each morsel for at least 20 times.
-Taking a short walk is a good way to get some light exercise. Walking time should be gradually increased until it reaches 20 minutes.
-You should drink at least eight glasses of water daily. Water helps push the food through the intestines and also helps lubricate intestinal tissues. When the body is dehydrated, the intestines absorb the fluids from the food waste, which in turn leads to hardened stools
- Avoiding alcohol and caffeine is also important as these substances contribute to dehydration.
-Use fish oil and castor oil-Fish oil is believed to encourage healthy digestion and castor oil produces a laxative effect when ingested
-Fruits and vegetables, which contain high amounts of fiber, aid in alleviating symptoms of constipation,Whole-grain bread, XXXXXXX oatmeal, beans and lentils can also relieve the problem so use it Instead of highly processed rice, eat brown rice, millet or bulgur.
-Eat 2 cups of fruit 3 cups of vegetables and about 35 grams of fiber per day
fruits: Generally all fruits, except banana and XXXXXXX fruit, are beneficial in the treatment of constipation.
Pears are beneficial in the treatment of constipation.
Guava fruit when eaten with seeds, gives roughage to the diet and helps in the normal evacuation of the bowels.
Grapes: have also proved highly beneficial in overcoming constipation. The grapes have the cellulose; natural sugar and organic acid make them a natural laxative fruit. Not only they clean the bowel, but also tones up the stomach and intestines to relieve the chronic constipation.
-While sitting on the toilet, support the feet on a small stool in order to achieve a normal position that aids in bowel movement.

Hope answer was helpful.
Feel free to follow up.
Thanks!
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Ramesh Kumar (2 days later)
Thanks dr for such a detailed explanation. Very useful. I have no pain now and stool size has also reduced due to fibre intake and workout. There
Is no bleeding in my case from day 1. But the skin is around half cm outside anus still. I am regularly taking warm water sits, fibre etc. Will it go inside after sometime? If it's a grade 4 haemorrhoids can surgery be avoided? Please advise.
doctor
Answered by Dr. Ramesh Kumar (50 minutes later)
Brief Answer:
Follow up.

Detailed Answer:
Hello again,
You have to go for conservative mangement as explained by me above.
Even in case of grade 4 hemorrhoids also regression rate is seen by conservative management also.


There are two types of hemorrhoids-
1)Internal hemorrhoids- Never bleed (90%) cases.
2)External henorrhoids-Bleeds.

Try conservative management for 3 months initially.

Thanks!
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Ramesh Kumar (23 minutes later)
Thanks for this dr. For 3 months therapy I am already following the first two. for the third point can you specify a medicine to be taken. Thirdly, request your gastroenterologist to prescribe you with oral Calcium Dobesilate-Doxium therapy for 3 months. Initially twice daily for 21 days followed by once daily for 10 weeks. Trials have shown that 3-month therapy can cause shrinkage of Hemorrhoids in almost 60% cases.It was demonstrated that calcium dobesilate decreased capillary permeability, inhibited platelet aggregation and improved blood viscosity; thus resulting in reduction of tissue edema-- for this point advise me the specific medicine with name and it's dose. I will go according to ur advise. Thanks !
doctor
Answered by Dr. Ramesh Kumar (16 minutes later)
Brief Answer:
Follow up.

Detailed Answer:
Hi,
Its available as brand name Doxium 500 mg(Calcium dobesilate is the salt).
Take it twice daily for 21 days and then continue it as once daily for 60 days.



But please attach a clear high defination photograph to make sure if its hemorrhoid or not.


Thanks.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Ramesh Kumar (1 hour later)
Hi dr I have sent you three images of the problem we discussed. Hope you received the same. If not please give me your email id. I can send you there. Thanks !
doctor
Answered by Dr. Ramesh Kumar (44 minutes later)
Brief Answer:
Follow up.

Detailed Answer:
Hi dear,

I've received and seen all the pictures.
It's hemorrhoid only.

So start treatment as already mentioned and see how you respond in three months.

Good luck!


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Dr. Ramesh Kumar

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Practicing since :1986

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Suggest treatment for constipation

Brief Answer: Most likely the mass is hemorrhoid. Detailed Answer: Hello Patient, Thank you for asking your query on HealthcareMagic. I am a Gastroenterologist and would be answering your query. Have gone through your details and i appreciate your concerns. As per your query answers are- Most luikely its hemorrhoid and not just fissure.Hemorrhoids are swollen veins in the lowest part of your rectum and anus. Sometimes the walls of these blood vessels stretch so thin that the veins bulge and get irritated, According to standard texts Hemorrhoids are classified as- Grade 1:hemorrhoid bulges into the canal but does not prolapse or fall completely into it. These may bleed. Grade 2: hemorrhoid protrudes past the anal verge with straining for a bowel movement or passage of flatus, but spontaneously return to their original internal position once the straining has subsided. Grade 3: the hemorrhoid may protrude past the anal verge without any straining and requires the patient to push them inside manually. Grade 4: the internal hemorrhoid always stays protruded or prolapsed and is at risk for thrombosis or strangulation should the anal muscles go into spasm. Your case is grade 4 hemorrhoid. So most likely in your case the hemorrhoid has progressed to Grade four now therefore it is non reducible. Initially we start with conservative management for at least 3 months- Suggestion for conservative management are- Start taking Syp. Lactulose 10-15ml once daily before going to bed. It is one of the most frequently used laxatives, tolerated very well by patients in long terms with minimal side effects. Using laxative would prevent straining while defecating. -Secondly, start using Prepration H (a combination containing contains Calcium Dobesilate, Hydrocortisone, Lignocaine, and Zinc.) locally over the prolapsed mass. Thirdly, request your gastroenterologist to prescribe you with oral Calcium Dobesilate-Doxium therapy for 3 months. Initially twice daily for 21 days followed by once daily for 10 weeks. Trials have shown that 3-month therapy can cause shrinkage of Hemorrhoids in almost 60% cases.It was demonstrated that calcium dobesilate decreased capillary permeability, inhibited platelet aggregation and improved blood viscosity; thus resulting in reduction of tissue edema. If not relieved in 3 months we have to plan for minimal invasive or surgical procedure like- 1)Rubber band ligation is a procedure in which the hemorrhoid is tied off at its base with rubber bands, cutting off the blood flow to the hemorrhoid. very effective with high success rate. 2sclerotherapy -In this procedure, a chemical solution is injected into the hemorrhoid tissue to shrink it may be less effective than rubber band ligation. Surgical procedures- Hemorrhoidectmy it removes excessive tissue. Hemorrhoidectomy is the most effective and complete way to treat hemorrhoids. Hemorrhoid stapling. This procedure, called stapled hemorrhoidectomy or stapled hemorrhoidopexy, blocks blood flow to hemorrhoidal tissue. It is typically used only for internal hemorrhoids. Meet you Gastroenterologist or general surgeon and discuss the options with him/her. Please attach a high defination clear picture of the mass if possible. Some general suggestions are- -Linseed: is extremely useful in difficult cases of constipation. One teaspoon of linseed with warm water should be taken at night for bulk and lubrication. -Proper chewing: The diet alone is not enough. Food should be properly chewed-each morsel for at least 20 times. -Taking a short walk is a good way to get some light exercise. Walking time should be gradually increased until it reaches 20 minutes. -You should drink at least eight glasses of water daily. Water helps push the food through the intestines and also helps lubricate intestinal tissues. When the body is dehydrated, the intestines absorb the fluids from the food waste, which in turn leads to hardened stools - Avoiding alcohol and caffeine is also important as these substances contribute to dehydration. -Use fish oil and castor oil-Fish oil is believed to encourage healthy digestion and castor oil produces a laxative effect when ingested -Fruits and vegetables, which contain high amounts of fiber, aid in alleviating symptoms of constipation,Whole-grain bread, XXXXXXX oatmeal, beans and lentils can also relieve the problem so use it Instead of highly processed rice, eat brown rice, millet or bulgur. -Eat 2 cups of fruit 3 cups of vegetables and about 35 grams of fiber per day fruits: Generally all fruits, except banana and XXXXXXX fruit, are beneficial in the treatment of constipation. Pears are beneficial in the treatment of constipation. Guava fruit when eaten with seeds, gives roughage to the diet and helps in the normal evacuation of the bowels. Grapes: have also proved highly beneficial in overcoming constipation. The grapes have the cellulose; natural sugar and organic acid make them a natural laxative fruit. Not only they clean the bowel, but also tones up the stomach and intestines to relieve the chronic constipation. -While sitting on the toilet, support the feet on a small stool in order to achieve a normal position that aids in bowel movement. Hope answer was helpful. Feel free to follow up. Thanks!