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Dr. David
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 47533
Experience:  Board Certified Physician
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Hi, I have had a problem when passing stool over the past

Customer Question

Hi,

I have had a problem when passing stool over the past few years. My bowel movements are regular (daily) but whenever I pass stool a lump protrudes. I have learnt to push this back in with a finger and wash the area, which presents no problem when at home. This can however cause problems when I am out and about. Lately I have noticed an uncomfortable feeling in the anus area. It is not painful but makes me aware of the area most of the time.
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. David replied 3 years ago.

Dr. David :

This is Dr. David

Dr. David :

it sounds like you have a bit of rectal prolapse.

Customer:

Hi Dr David

Dr. David :

you need to be doing kegel exercises to help strengthen your lower pelvic muscles.

Customer:

I have a photo taken today after a bowel movement if that is helpful.

Dr. David :

it could also be a hemorrhoid which is protruding out.

Dr. David :

you might need a steroid suppository to help calm down internal hemorrhoids which are swollen and inflamed.

Dr. David :

here are instructions to upload a photo

Dr. David :

type a word in the textbox and highlight it

then select the "chain" icon above the textbox or the paper clip icon to upload a jpg

this opens a window where you can click next to the text box to select the jpg or pdf file on your computer to upload into JustAnswer

Customer:

Full Size Image

Customer:

After replacing with a finger the anus appears normal

Dr. David :

this looks like a large internal hemorrhoid which is trying to come out.

Dr. David :

you need to soften your stools with a stool softener.

Dr. David :

this is not rectal prolapse.

Dr. David :

and you need to see a GI surgeon who can look inside with an anoscopy scope and perform hemorrhoid surgery to cut those internal hemorrhoids out.

Customer:

I exercise regularly and eat a high fibre diet, so mostly my stools are soft

Dr. David :

so you don't have this problem.

Dr. David :

soft stools are good.

Dr. David :

hard constipation can worsen this.

Dr. David :

but you do need to see a surgeon about this to fix this surgically

Dr. David :

or else it will continue to be a problem.

Customer:

What are the treatment options for this? I have heard of rubber band ligation?

Dr. David :

yes, that is what a surgeon would do on the inside.

Dr. David :

but it would be a procedure through an anoscopy scope

Dr. David :

since these are internal hemorrhoids.

Dr. David :

also steroid suppositories can be tried for a period of time to help decrease swelling.

Dr. David :

but these seem quite large.

Dr. David :

and most likely will need surgery.

Customer:

Okay. I would ideally like to avoid full haemorrhoid surgery if possible as I have heard the recovery time is extensive and very painful. In your opinion would rubber band ligation be effective as a less intensive alternative?

Dr. David :

recovery is not long and painful

Dr. David :

it is usually quick.

Dr. David :

that is what the hemorrhoid surgery would be

Dr. David :

ligation of the veins with sutures to tie them off

Dr. David :

sutures are better than rubber bands.

Dr. David :

the recovery is quick and easy.

Dr. David :

do not try to do this yourself with rubber bands.

Dr. David :

you have to see a surgeon about it to get it properly cut out.

Dr. David :

and tied off

Customer:

No I definitely would not do that! I intend to see a surgeon. What I mean is that there is hemorrhoidectomy versus rubber band ligation. I am hoping a surgeon would opt for the ligation method in my case?

Dr. David :

yes, I'm sure the surgeon would do ligation for you.

Dr. David :

I'm glad you are willing to see surgeon about this.

Dr. David :

ligation is the preferred way

Dr. David :

you will do fine.

Dr. David :

best of luck to you

Dr. David :

let me know if you have other questions.

Dr. David :

if done for now, please leave positive feedback below the chat box

Dr. David :

you might have to scroll down to see the ratings area below

Dr. David :

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Customer:

Thanks - finally I assume ligation would be done as a day case and not under general anaesthesia?

Dr. David :

you can always reach me as Dr David if you have other questions.

Dr. David :

thanks for using JustAnswer.com

Dr. David :

most likely no general anesthesia

Dr. David :

most likely conscious sedation or a spinal below the waist anesthesia would be fine.

Dr. David :

spinal or epidural below the waist anesthesia

Dr. David :

like they give to pregnant moms.

Dr. David :

it depends on the surgeon and anesthesia team.

Dr. David :

does that help?

Dr. David :

any other questions?

Customer:

I was under the impression it could be done in a doctor's office. Like this : http://www.webmd.com/a-to-z-guides/rubber-band-ligation-for-hemorrhoids

Dr. David :

yes, this can be done in the doctors office.

Dr. David :

that might be how the surgeon will do it.

Dr. David :

so no anesthesia for these methods

Customer:

You don't think they are too large?

Dr. David :

only an exam with anoscopy will be able to tell.

Dr. David :

you can't tell by just a photo.

Customer:

Okay. I will make an appointment. Many thanks for your help and I will leave good feedback.

Dr. David :

you are welcome

Dr. David :

thanks.

Dr. David :

let me know if you have other questions

Dr. David and 3 other Medical Specialists are ready to help you