Internal Hemorrhoids Following Severe Constipation Episode

Case at a Glance

A 27-year-old female presented with suspected internal hemorrhoids following a severe constipation episode that required emergency department intervention with enemas and manual disimpaction attempts.

Patient's Story

The patient reported a lifelong history of irregular bowel movements but had achieved some regularity with daily morning bowel movements in recent years. Two weeks prior to presentation, she experienced severe constipation lasting 6 days with significant abdominal pain. Due to the holiday period, she sought care at the emergency department where imaging revealed significant fecal impaction. Treatment included two enemas and attempted manual disimpaction, followed by prescription stool softeners and antispasmodics. Following this episode, the patient developed new symptoms consistent with internal hemorrhoids, including perianal pain, burning, and itching that worsened with sitting.

Initial Assessment

Patient presented with new-onset perianal discomfort following recent severe constipation and emergency interventions. Symptoms included burning, itching, and pain in the anal region, particularly exacerbated by prolonged sitting. No prior history of hemorrhoidal disease. Recent emergency department visit documented fecal impaction on CT imaging.

The Diagnostic Journey

Initial emergency department evaluation included abdominal X-ray showing moderate stool burden, followed by CT scan confirming extensive fecal impaction in the proximal colon. Current symptoms of perianal pain, burning, and positional discomfort are clinically consistent with internal hemorrhoids, likely secondary to straining and trauma from recent constipation episode and medical interventions.

Final Diagnosis

Internal hemorrhoids, likely secondary to severe constipation episode and associated straining/trauma from medical interventions including enemas and attempted manual disimpaction.

Treatment Plan

Conservative management including increased water intake, dietary modification to reduce processed foods, daily fiber supplementation, and bowel habit regulation. Patient advised to consider over-the-counter hemorrhoidal preparations (topical creams or suppositories) and warm sitz baths for symptom relief. Emphasis on preventing future constipation episodes through lifestyle modifications.

Outcome and Follow-up

Patient continuing conservative management at 1.5 weeks post-onset. Symptoms persist but patient implementing dietary and lifestyle modifications. Advised to follow up with primary care provider if symptoms worsen or fail to improve with conservative measures, or if rectal bleeding develops.