1. Is the affected person an infant or child?

See Elimination Problems in Infants and Children.

2. Do you have pain or discomfort with your bowel movements?

Go to Question 9.*

3. Do you have to strain when you have a bowel movement, and are your stools hard and dry?

CONSTIPATION can cause these symptoms.

Add more FIBER to your diet, and drink lots of fluids. Bulk-forming laxatives may also help relieve constipation. Check to see if any medicine you are taking could be causing constipation.

4. Do you have a fever, chills and intense pain near the anus even when you're not having a bowel movement?

You may have a PERIRECTAL ABSCESS, an infected area near the anus.

See your doctor.

5. Is there itching when you have a bowel movement?

Go to Question 9.*

6. Do you have a small reddish mass of tissue sticking out of your anus?

You may have a RECTAL PROLAPSE. People who have this condition may feel like they can't completely empty their bowels. They may also pass very small stools or be unable to control their bowel movements.

See your doctor.

7. Is there occasional bright red blood in your stools, and do you have a small, tender lump near the rectum?

You may have an external or thrombosed HEMORRHOID.

Using over-the-counter hemorrhoidal creams or suppositories and soaking the area in warm water may help relieve the pain and itching. If there's no improvement in 1 to 2 weeks, or if the bleeding continues, see your doctor.

8. Do you have itching around your rectum even when you're not having a bowel movement?

Rectal itching may be a sign of a YEAST INFECTION, ALLERGY to toilet paper or PINWORMS.

Nonprescription antifungal medications for yeast infections or antiparasitic medications for pinworms are available. If you think an allergy is your problem, try using white, unscented toilet paper. See your doctor if your symptoms don't improve.

*9. Do you have blood on or mixed in your bowel movements?

The blood may be from internal HEMORRHOIDS. Internal hemorrhoids usually don't cause any discomfort. But RECTAL CANCER is another possibility, especially if you're over age 40. Other signs of rectal cancer may include changes in the shape of your stools and a cramping pain in your lower stomach.

See your doctor. Hemorrhoids are often treated with over-the-counter creams or suppositories. Soaking in warm water may also help relieve any discomfort.

10. Are your bowel movements gray or whitish?

You may have a BLOCKAGE in or near your gallbladder, or you may have a LIVER DISEASE or INFECTION.

11. Do you have problems moving your bowels without a laxative or enema?

Overuse of laxatives can cause dependence on them.

Avoid using laxatives. Instead, try adding more FIBER to your diet, and drink lots of fluids. Keep in mind that it isn't necessary to have a bowel movement every day. A normal range is 3 times a day to 3 times a week.