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What Causes Pronounced Mons Pubis During Bowel Movement?

Posted on Fri, 11 Jul 2014

Question: I have Crohn's Disease with an anal stricture. Every time I strain to move my bowels (as a result of the stricture) I notice my mons pubis area appears more pronounced. I have been examined for hernias multiple times, and have no bulges. Just a puffy/larger than normal mons pubis area for men. Colorectal surgeon said not to worry about it, and that I'm just pushing onto a natural opening. Is this a sign of an impending hernia, or just swelling of underlying blood vessels, fatty tissue, etc.? If I keep straining and it keeps puffing out, will it eventually turn into a hernia?

P.S. I also used to be much heavier/obese prior to Crohn's onset (and lost drastic amounts of weight over a few years as a result of the disease).

Answered by Dr. Ashish Verma (2 hours later)

Brief Answer:
yes it can

Detailed Answer:
Hi,

Welcome to HealthcareMagic.

I have read your query and understand your concern.

Constipation or excessive straining during bowel movements or during urination, in short every act that leads to repeated excessive increase in intra-abdominal pressure (even chronic cough) are all well known risk XXXXXXX factors for hernia formation.

I would suggest that either you use a laxative or stool softener to ease your bowel movements or you get your stricture dilated or else you will sure land up with hernia if your straining continues.

And as you have drastically lost large amounts of weight in a few years, all your abdominal muscles will be lax, and maybe for that you are seeing the buldge, and lax amdominal muscles are again prone to develop hernia.

Hope I have been helpful.

Regards,
Dr. Ashish Verma

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Ashish Verma (8 hours later)

I am dilating the stricture regularly w/ Hegar dilator (largest diameter in the set). For some reason, when I get the sensation for bowel movement in the rectum, only small amounts come out w/out straining. CT scans and MRIs have shown no other blockages. Colorectal surgeon also recently did Examination Under Anesthesia and examined me with Sigmoidoscope. I take Metamucil twice daily in between my medications (2 hours apart), but that only seems to help somewhat. Is it possible there is an undetected blockage, or is this a motility/nervous issue? Is overuse of Metamucil a possibility?

Answered by Dr. Ashish Verma (1 hour later)

Brief Answer:
try lactulose syrup

Detailed Answer:
Hi,

If without straining only little comes out then it means that you are having formed stools of larger diameter, than that of your hegar dilator.

So i would suggest that you switch to a stool softener like syrup lactulose, that can make your stools liquid enough so that it can easily pass through the stricture.

You need to adjust the dose of it to suit your requirement. Start with 20 ml in the night for two nights. If still you need to strain much then you can increase the dose by 5ml and so on. If the stools becomes too watery then you need to reduce the dose. It has to be titered by you.

Stop Metamucil for a week till your bowel gets cleared fully, then you can restart it again very slowly, adjusting it so that you can maintain the desired stool consistency with minimum dose of both - metamucil and lactulose.

And i don't think that there is any undetected blockage. So don't worry about it.

Regards,
Dr. Ashish Verma

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Ashish Verma (7 hours later)

It appears that Lactulose Syrup requires a written prescription in the U.S. Is Magnesium Citrate or Miralax (Polyethylene Glycol), both of which are over the counter, equivalent?

Answered by Dr. Ashish Verma (6 hours later)

Brief Answer:
yes they are equivalent

Detailed Answer:
Hi Samy,

Yes, Miralax and magnesium citrate are equivalent but the later one is a bit strong.

So i would suggest that you try the Miralax. Take it after reconstitution as prescribed over the package for 2-3 days and then you may adjust the dose as required.

Regards,
Dr. Ashish Verma

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Above answer was peer-reviewed by : Dr. Prasad