What’s making me so windy and constipated?

Q

I AM very flatulent and

sometimes pass mucus. I also get constipated, for which I take a laxative. But even after going to the bathroom I still feel like I need to go again. Are these problems connected — and is there a cure?

Name and address supplied.

A

Many people find these kinds of symptoms difficult to discuss, so I commend you for raising this important topic.

The sensation of not being able to completely empty the rectum is called tenesmus. It is a constant feeling, a sense that you failed to get everything out and need to try again. Sometimes it also causes abdominal pain.

you have not mentioned bleeding, which is reassuring, but the passage of mucus isn’t normal.

Tenesmus is a symptom of an underlying condition and you must talk to your doctor about this and request referral for further investigation.

The most common potential cause is inflammation in the lower bowel, for instance due to inflammatory bowel disease such as Crohn’s disease.

The initial investigation, called a sigmoidoscopy, involves passing a thin viewer into the rectum and large intestine. The specialist might also suggest a colonoscopy in order to examine the full length of the large bowel.

The mucus and the tenesmus may be linked, though not necessarily, to the flatulence. The important thing is to seek an exact diagnosis.

Q

MY 65-year-old brother suffered a blood clot in his leg six months ago and has been on daily anticoagulant drugs since. But during a recent hospital check doctors said the clot is still there and always will be. Is this correct?

Jo Whyley, by email.

A

I underSTand your confusion. your brother was diagnosed with a deep vein thrombosis (dVT), presumably via a scan after he’d developed symptoms — the most common for dVT is unexplained swelling in the leg. It can also cause pain and an unexplained increase in visible veins in the lower part of the affected leg.

The veins below the knee are more superficial, so if a deep vein is obstructed by a clot, these superficial veins carry most, if not all, of the blood flow, and become very prominent (the veins higher up tend to be deeper and obscured by fat).

The danger of a dVT is that the clot, or part of it, can break off and travel through the bloodstream back to the heart.

as clots are soft and gel-like, it would be pumped through the chambers of the heart and into the lungs — leading to a potentially fatal blockage in a blood vessel there, known as a pulmonary embolism.

In your longer letter you mention your brother was prescribed rivaroxaban, a blood thinner designed to reduce the risk of a pulmonary embolism.

But this drug doesn’t completely dissolve the clot. Instead, it ‘stabilises’ it; meaning within days, and over the forthcoming weeks, the clot shrinks and becomes what is, in effect, scar material that won’t break off.

When your brother was examined again months later, it was this residual healed clot material that the doctor identified.

It’s no longer a blood clot, in the same sense, and it’s no longer accurate to describe it as a dVT.

although it might shrivel further, it will always be there.

an important question in anyone with a dVT is identifying the cause. When there is no obvious source — such as the immobility imposed by a long journey — the patient should undergo tests for thrombophilia, a condition that increases the risk of clots.

This can be caused by many factors, ranging from genetic diseases, such as protein C deficiency, to liver disorders.