Elimination Problems

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Follow this chart for more information about pain, itching or blood with a bowel movement.

SYMPTOMS DIAGNOSIS SELF-CARE
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1. Is the affected person an infant or child?


Yes

See Elimination Problems in Infants and Children.

No

2. Do you have pain or discomfort with your bowel movements?


No

Go to Question 9.*

Yes

3. Do you have to strain when you have a bowel movement, and are your stools hard and dry?


Yes

CONSTIPATION can cause these symptoms.

Add more FIBER to your diet, and drink lots of fluids. Bulk-forming laxatives may also help relieve constipation. Check to see if any medicine you are taking could be causing constipation.

No

4. Do you have a fever, chills and intense pain near the anus even when you're not having a bowel movement?


Yes

You may have a PERIRECTAL ABSCESS, an infected area near the anus.

See your doctor.

No

5. Is there itching when you have a bowel movement?


No

Go to Question 9.*

Yes

6. Do you have a small reddish mass of tissue sticking out of your anus?


Yes

You may have a RECTAL PROLAPSE. People who have this condition may feel like they can't completely empty their bowels. They may also pass very small stools or be unable to control their bowel movements.

See your doctor.

No

7. Is there occasional bright red blood in your stools, and do you have a small, tender lump near the rectum?


Yes

You may have an external or thrombosed HEMORRHOID.

Using over-the-counter hemorrhoidal creams or suppositories and soaking the area in warm water may help relieve the pain and itching. If there's no improvement in 1 to 2 weeks, or if the bleeding continues, see your doctor.

No

8. Do you have itching around your rectum even when you're not having a bowel movement?


Yes

Rectal itching may be a sign of a YEAST INFECTION, ALLERGY to toilet paper or PINWORMS.

Nonprescription antifungal medications for yeast infections or antiparasitic medications for pinworms are available. If you think an allergy is your problem, try using white, unscented toilet paper. See your doctor if your symptoms don't improve.

No

*9. Do you have blood on or mixed in your bowel movements?


Yes

The blood may be from internal HEMORRHOIDS. Internal hemorrhoids usually don't cause any discomfort. But RECTAL CANCER is another possibility, especially if you're over age 40. Other signs of rectal cancer may include changes in the shape of your stools and a cramping pain in your lower stomach.

See your doctor. Hemorrhoids are often treated with over-the-counter creams or suppositories. Soaking in warm water may also help relieve any discomfort.

No

10. Are your bowel movements gray or whitish?


Yes

You may have a BLOCKAGE in or near your gallbladder, or you may have a LIVER DISEASE or INFECTION.

SEE YOUR DOCTOR RIGHT AWAY.

No

11. Do you have problems moving your bowels without a laxative or enema?


Yes

Overuse of laxatives can cause dependence on them.

Avoid using laxatives. Instead, try adding more FIBER to your diet, and drink lots of fluids. Keep in mind that it isn't necessary to have a bowel movement every day. A normal range is 3 times a day to 3 times a week.

No
For more information, please talk to your doctor. If you think your problem is serious, call your doctor right away.  

This tool has been reviewed by doctors and is for general educational purposes only. It is not a substitute for medical advice. The information in this tool should not be relied upon to make decisions about your health. Always consult your family doctor with questions about your individual condition(s) and/or circumstances. Source: American Academy of Family Physicians. Family Health & Medical Guide. Dallas: Word Publishing; 1996.

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