DR FLO: Help, there is blood in my stool

Dr Flo, there are blood stains in my stool that come and go. I don't feel any pain when it happens. What could this be? Baraza

Dear Baraza,

Having blood after passing stool is a sign that something is actively bleeding at the time.

This could be due to a tear in the lining of the anus or rectum, because of friction from passing large stool, hard stool, or from diarrhoea.

The bleeding could also be due to haemorrhoids, otherwise known as piles. These are veins that bulge in the lower part of the rectum and anus. The walls of the veins stretch and get irritated, and easily get a tear and bleed. They can occur due to straining when passing stool e.g. due to constipation or diarrhoea; or any activity that causes repeated high pressure in the abdominal region e.g. a persistent cough and lifting weights.

To manage the problem, try and prevent constipation by taking a lot of fluid and a high fibre diet every day, exercise, schedule time each day for a bowel movement, and take your time; use baby wipes instead of toilet paper and take a sitz bath - sit in warm water for about 20 minutes twice a day to soothe the injured tissue.

A doctor can prescribe stool softeners and suppositories to heal the injured tissue.

Since the bleeding has persisted for a while, it would be advisable to see a surgeon, so that an examination can be done to visualise the lining of your anus, rectum and large intestines to see the cause of the bleeding.

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Dr Flo, I have had polycystic ovarian syndrome for more than 12 years. I have gone through so many ultrasounds, HSG exam and contraceptive pills. Is there a way to manage this? I plan to conceive. Help me, please. Anne

Dear Anne,

In polycystic ovarian syndrome, the ovary has many cysts containing immature eggs that do not reach the stage of ovulation. Hormone levels are altered, which disrupts the menstrual cycle. Extra androgen hormones (testosterone) are also produced.

The symptoms include irregular periods, heavy bleeding, acne, excessive hair growth, weight gain, hair loss on the scalp, and dark patches on some areas of the skin.

It can be managed by maintaining a low glycaemic index diet (get most carbohydrates from fruits, vegetables and whole grains), exercise, contraceptive pills and metformin.

Ovulation rarely happens, so it is difficult to conceive. However, with the help of a gynaecologist, you can get medication to induce ovulation for several cycles to see if conception will happen. If it doesn’t, the other options include intrauterine insemination (IUI) and in vitro fertilisation (IVF). Your partner may also need to be examined.

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Dr Flo, my husband takes long to get an erection and to ejaculate. We have seen a doctor and he has been tested for prostate, pressure, and sugar which all came out negative. He also has a urinating problem; he can push urine for like 10 minutes and if you happen to talk to him when urinating it gets lost and he has to wait again. He is 60 years old. Kindly advise. Concerned Wife.

Dear Concerned Wife,

With increase in age, it takes longer to get an erection, and to achieve an orgasm and ejaculation. Other issues that can contribute to this include reduced testosterone levels, nerve disorders, diabetes, hypertension, high cholesterol levels, blocked blood vessels, heart disease, excess alcohol intake, smoking and psychological disorders. Some hypertension medicines can delay erection and some anti-depressants can delay ejaculation.

With age, the prostate gland enlarges in most men, and it may cause problems with urinating because it squeezes the urethra. There is no known cause of the enlargement, though it is more common in men who have testicular abnormalities or have close male relatives with prostate problems.

Symptoms include incomplete emptying of the bladder; frequent urination, even at night; weak stream and dribbling at the end of urinating; leaking urine; needing to urinate urgently; having to force out urine; pain when passing urine and sometimes blood in urine.

It would be advisable to visit a urologist, for physical examination, prostate ultrasound and other tests.

At home, he should urinate as soon as he feels the urge, and have timed bathroom breaks, even if he doesn’t feel like going at the time.

Avoid alcohol, smoking and caffeine, keep warm, relax, get adequate sleep, eat healthy diet and get regular exercise, including Kegel’s exercises (contract the pelvic muscles as though stopping the flow of urine). Contract these muscles for about 10 seconds, 10 times in one set, six to 10 sets in a day.

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