Why Do I Need to Wipe Repeatedly After a Bowel Movement?

Post by Master, Doctor Mai Vien Phuong - Department of Examination & Internal Medicine - Vinmec Central Park International General Hospital 
 

If you find yourself using half a roll of toilet paper after each bowel movement, there's a chance you might have an underlying medical condition. Excessive wiping can lead to itching and discomfort. Ideally, you should only need to wipe two to three times after using the toilet. If you're experiencing any discomfort, consult a doctor if your symptoms persist.
 

1. Why do I need to wipe so much after using the toilet?

Several health conditions can make wiping more difficult or affect your ability to feel completely clean after using the toilet. 
Remember, everyone may need to wipe a little more than usual occasionally. But if you find that excessive wiping is the norm rather than the exception, consider that one of these conditions may be the underlying cause.

• Anal abscess or fistula:
  An anal abscess is an infection of the anal gland that causes pain, redness, and drainage in the rectal area. The drainage can be blood, pus, or stool. An untreated anal abscess can develop into a fistula (anal fistula is a small tunnel that forms between the end of the bowel and the skin near the anus).  

• Excess skin tags: 
  Skin tags around the anus are growths of skin caused by friction, irritation, or recurrent inflammation. Common causes include:

  • Chronic diarrhea
  • Constipation
  • Hemorrhoids
  • Crohn's disease 

  Excess skin can trap stool and make it difficult to clean the anal and rectal area after a bowel movement. 

• Fecal incontinence: 
  Fecal incontinence is also known as bowel leakage. It occurs when you have difficulty controlling your bowel movements. You may leak stool when you pass gas or find yourself leaking stool throughout the day.
• Hemorrhoids: 
  Hemorrhoids are swollen veins inside or outside the rectum. They can cause symptoms such as itching, pain, and bleeding. 
  Hemorrhoids are quite common. Studies estimate that 1 in 20 adults in the United States and about half of all adults over the age of 50 have hemorrhoids. Hemorrhoids can be difficult to clean completely because stool can become trapped in them.  

• Anal itching: 
  Also known as pruritus ani, this condition can be caused by skin irritants such as:

  • Over-cleaning
  • Strong soaps or perfumes
  • Sweat 

  In addition to itching, anal itching can cause irritation, burning, and discomfort.
   

2. Complications of Improper Wiping

Wiping after a bowel movement is not just about cleanliness.
For women, not wiping properly can increase the risk of conditions such as:

• Vaginal irritation
• Urinary tract infections (UTIs)
• Vaginitis

Men can experience similar problems, including:  

• Urinary tract infections
• Itching
• Anal discomfort
   

3. Tips for Thorough Wiping After a Bowel Movement

Several methods can improve the feeling of cleanliness after a bowel movement.

• Use wet wipes: 
  Wet wipes can prevent irritation from dry toilet paper. Even flushable wipes can be effective. 
  Look for unscented wipes designed for sensitive skin. Otherwise, these wipes can cause irritation and actually worsen your symptoms.
• Check your wiping direction: 
  Always wipe from front to back to avoid introducing unwanted bacteria into the urethra.
• Cleanse with a bidet or squeeze bottle: 
  A bidet allows water to flush over the rectum to clean it. You should squeeze the bottle from front to back so that the water flows backward.
• Avoid being too rough or wiping excessively: 
  Wiping too much or too hard can irritate the rectum. Instead of wiping excessively or too hard, rinse the area clean.
• Wear an incontinence pad:
  Sometimes, if you have frequent loose stools, incontinence pads can help you feel clean. They can absorb some stool and prevent your underwear from getting soiled.

• Other Ways:
  Besides improving your wiping technique, the following steps can help treat some of the underlying causes that make wiping difficult in the first place:

  • Epsom salt baths or warm sitz baths: These can help reduce inflammation in the rectal area. This can alleviate itching and irritation after a bowel movement.
  • Increase fiber intake: If your discomfort is related to constipation, try eating more fruits, vegetables, and whole grains.
  • Increase your water intake: Along with increasing fiber, drinking more water will help bulk up your stool and make bowel movements easier.
  • Use over-the-counter (OTC) stool softeners: These can reduce straining that may aggravate hemorrhoids.

  As well as tips to try, there are also things to avoid. These include:

• Avoid scented products around the rectal area, such as lotions, toilet paper, or soaps. These can cause irritation.
• Avoid foods and drinks that irritate your digestive system and can lead to diarrhea. Triggers will vary but may include:
  • Spicy foods
  • Caffeinated foods and drinks
  • Onions
  • Artificial sweeteners
     

4. When to talk to a doctor

If you experience severe and sudden pain related to bowel movements, seek medical attention promptly. 
You should also seek immediate medical care if you have unexplained bleeding. This may look like your stool is red or has the consistency of coffee grounds. Bleeding can indicate several serious conditions, such as:

• Upper gastrointestinal bleeding
• Anal fistula
• Severe hemorrhoids

Talk to your doctor if over-the-counter treatments are not effective for your bowel problems and the need for excessive wiping after a bowel movement. Your doctor may prescribe medication or suggest treatments such as:

• Bowel habit training: Training yourself to have a bowel movement at the same time each day can reduce the likelihood of incontinence.
• Pelvic floor exercises: You may need to see a pelvic floor therapist who can help you perform pelvic floor exercises. These can help reduce the likelihood of incontinence.
• Prescription medications: Your doctor may prescribe medications to reduce diarrhea or symptoms that may occur with conditions like Crohn's disease, irritable bowel syndrome (IBS), and ulcerative colitis. If constipation is the underlying cause, they may prescribe a stool softener or laxative for temporary use.  
• Surgery: In rare cases, if over-the-counter or prescription treatments are not effective, your doctor may recommend surgery to reduce severe leakage.

Please dial HOTLINE for more information or register for an appointment HERE. Download MyVinmec app to make appointments faster and to manage your bookings easily.

References
Chang J, et al. (2016). Anal health care basics. ncbi.nlm.nih.gov/pmc/articles/PMC5101094/ Curran K, et al. (2018). Causes of bowel leakage. ouh.nhs.uk/patient-guide/leaflets/files/11857Pbowel.pdf Definition & facts of hemorrhoids. (2016). niddk.nih.gov/health-information/digestive-diseases/hemorrhoids/definition-facts Treatment of fecal incontinence. (2017). niddk.nih.gov/health-information/digestive-diseases/bowel-control-problems-fecal-incontinence/treatment