By Dr. Mona Alqulali
Special to the Herald
June 24, 2009 09:32 am
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DEAR DR. MONA: I am troubled by constipation which does not seem to be relieved except with a laxative. Is there anything I can do about this? Additionally, I have painful hemorrhoids and they bleed when I stop taking the laxative. I feel addicted to the laxatives and am afraid I cannot live without them. Help! — Marie
DEAR MARIE: If constipation is the only symptom you have when you stop taking laxatives, chances are that you are not addicted to them. It sounds as though you have two different but related problems: how to treat your hemorrhoids and how to prevent constipation.
Constipation is the biggest enemy of hemorrhoids. Laxative use is good for occasional treatment of constipation. Of course, the misuse of laxatives can lead to addiction. Some individuals use laxatives as a weight loss method, and therefore, have difficulty stopping them. Those individuals complain of heart palpitations, leg swelling, and weakness when they try to stop.
I think the solution to your problem lies in controlling your constipation which, in turn, will help your hemorrhoids. Why do some people have constipation and others do not?
The food you eat is processed in the digestive system and the waste is moved to the large intestine where the water contents and the salts are reabsorbed. If a lot of water is absorbed the stool may become harder and constipation results. In addition, if the bowel muscle movement is disorganized, one may suffer from constipation. Illness, pregnancy, age, lack of physical activity, low-fiber diet, inadequate fluid intake, and lack of attention to need to use the restroom can all slow down the movement of the waste. Some medications for high blood pressure, Parkinson’s disease, depression, and narcotics may worsen constipation. Occasionally constipation may be a sign of a more serious condition such as colorectal cancer, autoimmune disease, hormonal disturbances, and pelvic floor dysfunction.
With complaints such as yours, we encourage lifestyle changes — taking a fiber supplement, such as Konsyl, oat bran, Metamucil, or Citrucel can help a lot. These natural supplements are safe and will help soften the stool especially if combined with adequate water intake. If you add the fibers too quickly, you may experience a lot of gas, so do it slowly.
Stool softeners such as docusate (Colace, Surfak) or mineral oil soften the fecal matter and make it easier to pass. The use of mineral oil may interfere with absorption of fat soluble vitamins, and may be accidentally aspirated in the lungs causing pneumonia, so the stool softeners would be preferable. A mild laxative is milk of magnesia and that may also be taken if needed.
These are all conservative methods, and if they do not work, prescription medications such as tegaserod (Zelnorm) may help chronic constipation on a short-term basis for people younger than 65. It works by helping your intestinal muscles contract more effectively. Possible side effects include diarrhea, stomach pain and black, tarry stools. If any of these side effects occur, let your doctor know immediately.
Biofeedback and physical therapy may help improve defecation muscles. In pregnancy, eating high fiber diet foods such as fruits, vegetables, and whole grains is important, as well as fluid intake. Exercise during pregnancy including swimming and walking may help constipation.
Hemorrhoids are varicose veins but instead of being in the legs they occur in the rectum and anus. When inflamed they swell up, burn, itch, are painful, and bleed. Increased pressure in the rectum leads to hemorrhoids and this can be caused by constipation, constant straining, sitting for a long time, diarrhea, chronic coughing, heavy lifting and pregnancy.
In addition to avoiding or reducing these risks, you can treat your hemorrhoids with sitz baths (soaking the rectal area in hot water, in a shallow bath) for 15-20 minutes, 3-4 times/day. Pain medicine may be used for the irritation, but the burning and itching respond best to surface-acting creams and suppositories such as Anusol or Preparation H. These may also help shrink the hemorrhoids. If using these techniques and treatments for up to 4 weeks does not provide relief, consult your physician. If you have severe hemorrhoid pain, see your physician immediately.
Hope all of this helps your very common problem. In today’s society, with so much fast-food consumption, one must pay special attention to getting the fibers necessary for normal bowel activity. Eating vegetables, whole grain cereals and whole grain bread, and beans are far preferable to a diet of processed white bread, hamburger and hotdog buns and a diet lacking fruits and vegetables.
So Marie, I know it’s hard to change eating habits and make lifestyle changes but it’s the solution that will help you deal with both hemorrhoids and constipation.
Dr. Mona Alqulali is a board certified OB-GYN.
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