Difficulty Defaecating

Synonyms: Susah Nak Berak / Susah Buang Air Besar / Sembelit / Constipation / Pain per Rectum / Nil BO

Difficulty to get the faeces out of the rectum happens at odd times and difficult times. It can happen to anyone at any time. It is unexpected but it happens. There are conditions that can predispose people to have difficulties getting their bowels to open normally. Lack of water, fibre and oil in the diet is the #1 cause.

People who have this problem include:

1. pregnant mothers (the fetus presses on the colon and rectum, stalling bowel movement) 
2. mothers during confinement period (they refuse to eat vegetables and fruits or drink water)
3. undergraduate students who return from overseas (sudden diet change) 
4. students who return home from elsewhere (sudden diet change)
5. those who are bed-ridden (no motion to aid bowel movement, stagnant faeces)
6. people who are sedentary and hardly move from their seats (no motion, stagnant faeces)
7. people in leg cast and can't move about much
8. people who work/workout/exercise, sweat a lot but don't replace the water losses (dry faeces)
9. zero-to-low fibre diet (no vegetables or fruits in the diet) (faeces hard, dry, small volume) 
10. sudden change in diet (eg lacks fibre, water and oil)
11. people who habitually/occasionally drink very little fluids (usually in males, because they don't want to go to toilet so often during working hours or while on the job) 
12. other not specified above

Often, people don't know which foodstuff contains fibre and retains water. Sometimes, people don't understand the links between fibre, water, faecal volume, water absorption in the colon, and how the faeces exits the anus.

There must be a certain amount of food which must be eaten, and which goes on to form faeces. Depending on the fibre content of the food/diet consumed, the food/faeces will/will not be able to hold sufficient amount of water from the intestines to the anus. If a large volume of food is eaten, and a good volume of fluid is consumed, the food is well hydrated inside the gastrointestinal track (all along the intestines, down to the colon and rectum). The faeces that exits is full (large, big diameter) and soft and exits easily.

However, if water consumption is reduced despite eating sufficient amount of food, the food lacks water while in transit through the intestines down to the colon and rectum. By the time it becomes faeces, it is already dry. When the faeces is dry, it becomes drier in the colon where water absorption is maximum. This can result in stone-hard faeces which is difficult to extrude from the anus. Forced extrusion can result in anal tear and bleeding, which can be painful when you try to wash the area.

Not defaecating daily can also result in the faeces gathering in the colon/rectum and creating a pouch. Trying to push faeces out of this pouch is difficult since the faeces will have balled-up (jadi bola keras). Straining to get hard faeces out of the anus can cause additional pain and bleeding (occult blood) as the hard faeces rub against the thinned walls of the colon/rectum/anus. Soapy water may help to break up the faeces but is difficult to do alone at home. This can be done in the clinic.

If you are faced with a painful rectum/colon/anus and you have problems defaecating, nil BO (no bowel open), tak boleh berak, or only a little piece of faeces comes out, then you have to do something practical before things get worse.

Here are some suggestions which my husband and I have tried and which worked for us, and some people close to us (my father, daughter and one of my nieces). Try one/two or a few of these remedies; some may work/not work for you:

1. Drink lots of water at every meal as you possibly can or a glass every hour
2. Drink fruit juices daily (orange, apple, grapefruit, mango, grape, pomegranate, prune, tomato, guava, etc)
3. Drink any milk drink or food (yogurt, lassi, milk, ice-cream, etc - they contain fat/oil)
4. Drink a tablespoonful of olive oil, and drink some water at night before going to bed
5. Eat a tablespoonful of fried/roasted cashew nuts (don't eat too much or you will get diarrhoea)
6. Eat 3 raisins (any size, colour or type) - don't overeat or you will get diarrhoea
7. Eat half a cup of stewed green apples (Granny Smith) - sweetened/unsweetened
8. Eat half a cup of unsweetened/sweetened fruit cocktail
9. Eat half a cup of sweetened/unsweetened pineapple cubes
10. Eat 2 small bananas and drink a cup of orange juice
11. Eat 3 boiled prunes and its juice
12. Eat 3-7 dates and drink some water
13. Eat half a cup of creamed corn
14. Eat half a cup of oats porridge - make it runny and not thick
15. Eat rice porridge (bubur or nasi air)
16. Eat soft foods 
17. Eat fried vegetables - kangkong, lettuce or kerabu pucuk paku
18. Eat agar-agar, agar emulsion, jello, jellies or soft puddings
19. Eat a tablespoonful of honey (don't eat too much or you will get diarrhoea)

Keep eating and drinking as above till the problem is over and normal bowel returns. Have some rest.

Once the problem is over, do not eat hard food (meat, burgers, drumstick, satay), processed/low fibre food or dried food (breads, buns, biscuits, cakes) without increasing your water, vegetables and fruit intakes.

If the anus is sore, dab some olive oil or apply lanolin (wool fat).