Constipation is a common bowel symptom and affects both males and females of all age groups. It is estimated that chronic constipation affects about 15% of Americans. However, it may be far more prevalent as many people do not seek medical attention for constipation and attempt to treat it on their own. Furthermore constipation may either be acute where it lasts for only a few days to weeks before resolving. On the other hand, constipation may be chronic and can persist for years or even decades.
Constipation and Bleeding
Constipation and bleeding in the gastrointestinal tract are two different clinical feaures. Sometimes both may be linked and constipation can cause bleeding, particularly from the rectum or anus.
Bowel habit can vary from one person to another. However, there is a range which is considered normal. Passing stool between three times a day to three times a week is normal bowel habit. Constipation is having less than three bowel movements in a week. Apart from the frequency, the stool is generally hard and difficult to pass out. Most people with constipation have to strain to have a bowel movement.
Bleeding from the gut occurs for several reasons and may arise from any part of the gut. When the bleeding is minor, it may not be noticed during a bowel movement or in the stool. Extensive bleeding can alter the color of the stool and appear as gross blood in the stool. Most of the time bleeding from higher up in the gut (mouth, throat, esophagus, stomach and first half of the small intestine) does not cause overtly bloody stool.
Read more on bleeding in stool.
Instead the blood degrades and causes dark, tarry stools known as melena. Bleeding from lower down the gut (second half of the small intestine, colon or rectum) may appears as fresh red blood in the stool. This is known as hematochezia. However, bleeding can also arise from the anus or perianal region and mix with the stool during a bowel movement.
Causes of Constipation and Blood in the Stool
There are various different causes of constipation and blood in the stool. Only a few conditions cause both symptoms and some of the more common of these conditions has been discussed below. Chronic constipation can cause blood in the stool due to anal and/or rectal bleeding. The causes of upper gastrointestinal bleeding that may occur with constipation has not been discussed since the blood is more likely to be degraded and not visible in the stool.
Read more on bloody stool.
Hemorrhoids (piles) is one of the common complications of constipation. It may arise for a number of reasons, such as straining when passing stool, sitting on the toilet for long periods as well as injury to the rectum due to hard and dry stool. All of these causative factors are common occurrences in constipation.
In hemorrhoids, the rectal veins become swollen and bleed easily. This bleeding tends to occur during a bowel movement. The blood is usually fresh – a bright red color – with streaks of blood evident when wiping after passing stool. In severe cases with profuse bleeding, the stool may be coated with blood.
Anal fissures are another common complication of constipation. These are tiny tears in the mucosa that lines the anus. Passing hard, dry and enlarged stools as well as straining during bowel movements are some of the more common causes of anal fissures.
The bleeding is evident with a bowel movement. Usually the bleeding is not profuse and blood does not coat the stool. However, there are streaks of blood when wiping after a bowel movement. Pain, a burning sensation and itching of the anus, especially after a bowel movement, are some of the other common symptoms.
Diverticulitis is a condition where there are bulges in the colon which become inflamed. These outpouchings are known as diverticula and more often occurs after the age of 40 years. When not inflamed, the diverticula does not usually cause any symptoms. It becomes inflamed for various reason, such as infections. Diverticulitis usually presents with constipation (sometimes with diarrhea) and abdominal pain. Blood in the stool may also be present.
Inflammatory Bowel Disease
Inflammatory bowel disease (IBD) may present with both alterations in bowel habit like constipation as well as rectal bleeding. This may occur in both ulcerative colitis and Crohn’s disease. Constipation is uncommon in IBD but can occur. Sometimes it may be due to the overuse of antidiarrheal drugs to counteract the diarrhea that is more common in IBD. The inflammation and ulceration of the bowels is usually the source of bleeding.
Polyps in the colon are abnormal growths that protrude from the wall of the colon. Most of the time it is benign (non-cancerous) but sometimes it can turn malignant (cancerous). Multiple large polyps can cause a partial obstruction in the colon and lead to constipation. There may also be bleeding from these polyps which contributes to the blood in the stool alongside constipation.
Cancer in the colon or rectum may cause alterations in bowel habit, either constipation or diarrhea, as well as rectal bleeding. This is a more serious cause of constipation with blood in the stool. It should be suspected when there is a family history of personal history of colorectal cancer as well as unintentional weight loss along with symptoms like constipation and rectal bleeding.
Remedies and Treatment
The exact cause of constipation with blood in the stool needs to be diagnosed. This usually requires further diagnostic investigations. As mentioned, constipation and blood in the stool may not be related or caused by the same condition. Blood in the stool is often considered as the more serious of the two symptoms. Depending on the underlying cause, the appropriate medical treatment must be prescribed by a medical doctor.
The following remedies are more effective for easing constipation. However, in cases where blood in the stool is related to constipation, the bleeding may also ease with these remedies.
- Increase water intake to at least 2 liters (68oz) daily. Sometimes higher water volume is necessary. Avoid diuretics like alcohol and coffee that may hasten water loss.
- Consume more fiber-rich foods including fruits, vegetables and wholegrains. Fiber supplements may be necessary to assist in easing constipation.
- Exercise can also help with constipation. It may increase bowel activity and abdominal pressure which may stimulate a bowel movement.
Read more on easy bowel movement remedies.