Unusual Bathroom Routine Leads to Unexpected Painful Consequences

Dear Dr. Stuart Fischer,

Addressing this issue feels a bit awkward, but I am seeking clarity on how much I should worry. I have developed an unfortunate habit of getting caught up in endless scrolling on social media platforms like Instagram and TikTok while I am on the toilet.

There have been several occasions when I lost track of time, realizing only after 15 to 20 minutes that I had completed my bathroom visit but remained seated. Sometimes, I sit for so long that my legs become numb.

A few weeks back, I began noticing blood in the toilet water. Being a healthy 35-year-old, I believed this was unusual for me.

Initially, I suspected my prolonged doomscrolling sessions might be the cause, so I made a conscious effort to leave my phone outside the bathroom. Despite this change, I am still noticing blood. Is this something that should cause concern?

I thought my endless doomscrolling habit was to blame, so I stopped bringing my phone into the bathroom, but I’m still seeing blood in the toilet. Should I be worried?

Thank you,

Bad Bathroom Behavior 

Dear Bad Bathroom Behavior,

Thank you for your honesty here. As a seasoned gastroenterologist and endoscopist might tell you, almost everyone eventually develops some sort of internal hemorrhoids. And this could very well be what’s causing your bloody stools, which are worrisome and should always result in a trip to your doctor for an examination. 

Constipation or irritable bowel syndrome are obvious risk factors for this condition, but there are also many others.

By sitting too long on the ‘throne,’ you are putting excessive pressure on the tiny veins that line the sigmoid colon, which is the endpoint of the large intestine. And that extra pressure can cause those veins to ‘pop,’ leading to BRBPR. 

Never heard of it? BRBPR – or Bright Red Blood Per Rectum – is a common occurrence and strong indication of a hemorrhoid.

The immediate medical treatments for bleeding hemorrhoids are well-known and very straight-forward: Anusol (or any similar ointment) 2-3 times per day to relieve pain and inflammation; 100 mg of Colace (or similar stool softener) 2-3 times a day to prevent constipation; and, perhaps best of all, warm sitz baths, which draw fluid out of the hemorrhoid leading to much-needed relief. Most likely, the body will repair the hemorrhoidal vein on its own within a few days.

There are, as you might imagine, serious illnesses that can mimic hemorrhoidal bleeding; these can include diverticulitis and vascular ectasias (bleeding from little brittle veins higher up the large intestine). Such conditions may result in particularly heavy rectal bleeding. 

Blood in the stool can also be a symptom of colon cancer, which is rising among young people. So be sure to seek urgent medical attention if you experience rectal bleeding accompanied by lower abdominal pain, unexplained weight loss, fever, diarrhea, or if bleeding remains persistent. 

Expect the bleeding from hemorrhoids to last around 2-3 days until the veins are repaired. People taking an anti-coagulant such as Coumadin and Eliquis will have more bleeding than others as well as longer recuperation times. Your health care provider will tell you if such medications should be paused or reduced.

Since blood belongs inside the human body, not outside, be very cautious about your bowel habits. And thank you again for your question. 

Dear Dr. Fischer, 

I’ve struggled with migraines my entire adult life, but recently the symptoms have gotten worse. I’m 44 and manage my high blood pressure, but otherwise I think I am healthy, except for those darn headaches. 

When I feel a bad one coming on, I cancel my appointments and call out sick from work. I become extremely sensitive to light and the jack hammers in my head start pounding. I’ve even thrown up because the pain has gotten so bad.

I’ve tried treating the migraines with over-the-counter pain killers, but they don’t do a thing. Should I be worried?

Sincerely,

Pain in the Head

Dear Pain in the Head,

Migraine headaches are a potentially debilitating condition which can affect up to 10 percent of Americans. You’ve described the classic symptoms: Painful throbbing on one side of the head, often accompanied by nausea, vomiting and extreme sensitivity to light.

Even with the advances of modern medicine, the brain remains a surprisingly complex and mysterious organ. Which is why the exact causes of migraines are still not entirely known. What we do know is that genetics play a strong part – if a parent suffered from migraines, you have a 50 percent of suffering from them yourself.

During a migraine, nerves embedded in your blood vessels send pain signals to your brain which release inflammatory secretions. The blood vessels, nerves and various layers of protective tissue within your skull then compound and amplify this painful process, causing extreme discomfort. This is why even in someone with a long history of headaches, migraines can prove particularly difficult to manage.

What triggers migraine spasms? Everything from stress and other forms of psychological issues to foods, allergens and gastrointestinal disorders such as irritable bowel syndrome. Usually, an exact cause cannot be determined, which is why treatment can be so difficult to figure out.

When I was an emergency room attending physician, many people arrived with unrelenting headaches and were given narcotics such as Demerol or Vicodin for relief. This treatment is no longer recommended because narcotics only treat the symptoms of migraines, not the causes; narcotics can also result in addiction.

It’s extremely important to seek medical care at the earliest opportunity when dealing with the possibility of migraines. There are plenty of other ailments that can resemble migraines but require a different treatment plan.

Migraines are typically preceded by visual abnormalities called auras, and a classic migraine is worsened by intense lighting or loud sounds. These phenomena are unique to migraines. But double vision (diplopia), epileptic seizures, altered level of consciousness and arm/leg weakness are not. Which is why a precise diagnosis from a neurologist is so crucial. You might need specialized testing (e.g. laboratory or radiologic), which fortunately, has progressed over the past few decades.

Treating migraines is what we describe in medical terms as bi-modal or two-step: First, you must identify those triggers. Then, choose the right medication to curtail or limit the frequency of migraine attacks while avoiding side effects. As for over-the-counter medications, they make sense for minor headaches, but not migraines.

Your migraines seem to be impacting your life, which is why my advice is to seek professional treatment with a qualified physician.

Dear Dr. Fischer,

I have a beautiful daughter in her early 20s. She has always had a healthy appetite but struggled with her body image, so both her doctor and I thought that it was harmless for her to go online and order one of those increasingly popular weight loss drugs. 

But now she’s dropped from 150 pounds to 110 pounds – and she’s 5’4′! Not only have her eating habits changed, but her entire attitude toward food is also different. It’s like she’s lost all the joy that our family shared around meals. And she’s TOO skinny! 

I fear if I tell her to stop using the drugs, she’ll gain the weight back and be upset with herself and me! But I don’t want her to keep shrinking. 

How worried should I be?

Sincerely,

Dad With a Shrinking Daughter

There is both clinical and anecdotal evidence that using the weight-loss medications known as GLP-1s (such as Ozempic or Wegovy) can cause or worsens eating disorders including anorexia or bulimia

Dear Shrinking-Daughter Dad:

I am sad to read about your situation at home. There is both clinical and anecdotal evidence that using the weight-loss medications known as GLP-1s (such as Ozempic or Wegovy) can cause or worsen eating disorders including anorexia or bulimia. The good news here is that your daughter has a dad who can spot such complications early.

The first step is to connect with the physician prescribing the weight-loss medication and consider adjusting her dosage. Or perhaps even ending GLP-1 usage entirely.

But there is a mental component to this physical situation that must be addressed as well. And while behavioral changes will help, your daughter likely needs some sort of additional support. Because left untreated, restricted eating conditions such as bulimia and anorexia can cause serious harm to the body.

Extreme weight loss or continued restrictive eating patterns can lead to abnormal values of serum electrolytes, throwing the body’s pH into a state of contraction alkalosis. This is as dangerous as it sounds – often resulting in muscle cramps, nausea and fatigue. More worrisome problems, such as osteoporosis, heart disease and even infertility, can also occur.

I’ve sometimes generalized conditions around extreme reduced eating as an inability to accept oneself… whether in appearance or behavior. Nobody’s perfect, and few of us will ever look like Sydney Sweeney or Hudson Williams. The sooner we accept this, the better. And this is why treatment can be so valuable.

There’s no simple ‘cure’ for anorexia and bulimia and no antidepressants or other psychotropic medications that can easily resolve it, at least not yet. So I would recommend some type of group therapy involving the entire family rather than only focusing on your daughter. She needs love and support from the people she trusts to love and support her the most. What she doesn’t need is to feel like ‘she’ is the problem, so focus instead on solutions. Your daughter needs to understand that satisfying her appetite is normal and healthy. She also needs to understand that having a healthy weight does not mean she’s overweight.

The key here is intervention, which is why the sooner the condition is identified, the better the chance for improvement and recovery. Accepting the problem by all family members is a good first step. 

So good job, Dad!