Get your health question answered instantly from our pool of 18000+ doctors from over 80 specialties

163 Doctors Online
Doctor Image
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

I will be looking into your question and guiding you through the process. Please write your question below.

Suggest treatment for constipation

Answered by
Dr.
Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2161 Questions

default
Posted on Sat, 8 Jul 2017 in Digestion and Bowels
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
default
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
default
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
default
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
doctor
premium_optimized

The User accepted the expert's answer

Share on
Question is related to
Diseases and Conditions ,   ,   ,  
Drug/Medication
Treatment/Therapy
Medical Procedures

Recent questions on  Chronic constipation

doctor1 MD

I am a 36 years old female with more than ten years history of chronic bloating and chronic constipation . Different tests showed no abnormalities in my bowels, so Gastro suspected IBS-C and just recommended to manage with diet and laxative (Milk of Mg, Miralax, etc). I tried drugs like zelnorm and amitiza w/o success. Lactulose made bloating even worst. Also, off-label use of a drug similar to colchicine , which name I can t remember. This one seemed to work but stopped it because I was afraid of its teratogenic effects. High-fiber diet does not make a difference. Eighteen months ago, I gave birth, and bloating and constipation were a little better after delivery. About a month ago, constipation and bloating have been terrible again, and started to have symptoms like an UTI. The OB-GYN diagnosed me with Interstitial cystitis . I am currently, taking Elmiron, Hydroxyzine , IC-friendly diet, and having a series of bladder instillations. I feel better regarding my IC symptoms, but noticed that whenever the constipation and bloating are bad, IC flares up. Currently, I am having liquid bowel movements (with Milk of Mg) and noticed my breath and stool smell like a chemical substance. Bloating is still there, even if I have a bowel movement, and aggravates along the day. I am following the IC-friendly diet, but there are some things that are IC friendly (ie wheat), that aggravates my GI problem. I read about a low FODMAP diet, but I would like to consult a Gastro about these because I am feeling like doing both diets is very limiting. Also, I would like to have things under control as I am thinking of getting pregnant again. I am worry about nutrition, and gaining weight during pregnancy. I will see a gastro in a couple of weeks, and want to bring up this IC diagnosis, and possibly evaluate for SIBO or celiac. No Dr has ever mentioned any of these conditions, but I read that IBS-C and these have overlapping symptoms and you can end up being misdiagnosed. Can you please provide an opinion? I need some help in the meantime.

doctor1 MD

I have a 3 yrs. Old son born with imperforated anus He started a cholostomy, which closed after one yr. Now he is suffering from chronic constipation and mild fever . He us investigated for ESR / 56 mg/ dl. BA meal and follow through shows distention in colon And anus. Dear dr. What should be the suggested Rx. and treatment for My son condition. With all regards.

doctor1 MD

i have been suffering from chronic constipation , bloated stomach and always burping for 3 years from now. i just lose bowel after 2 to 3 days but im not still satisfied with the stool i release. sometimes it s long and sometimes short that makes me discomfort. Just this june i was diagnosed as HIV positive and i suspect that this long term disease that i got is ileocecal TB since it s an infection or opportunistic infection can be brought by the virus itself. I undergone colonoscopy and endoscopy 2 years ago but still the doctor couldn t find what s the cause of this chronic constipation and the like. That s why i suspect it s ileocecal TB. pls. advise me doc what to do. tnx and more power...

doctor1 MD

hello dr my chilld having chronic constipation since 5 months female child 18 month giving all kind of allopathic drugs ,like creamaffin lactulose syrup for 5 months no use finally dr give a soium phosphate enema externally 3days once in 30 days , dr diagnose a complaints of HIRCHESBURGS DISEASE now what going to do sir.

doctor1 MD

chronic constipation due to seroquel

doctor1 MD

Yes, I have had a scratchy sound to my voice the last two years and it takes extra abdominal muscle to phonate. Also I get fatigued very easily. Is this possibly a case of Parkinson"s disease?

doctor1 MD

I have a history of eatable bowel syndrome with constipation caused by a long use of opioids for fibromyalgia I stoped using the opioids 5 years ago but still suffer from a lack of nerve res ponce in my intentions with slow bowels so much so that...