Tenesmus is an intense, urgent feeling of needing to have a bowel movement even when no stool is passed. It often comes with a sense that the bowel did not fully empty.
Tenesmus is commonly linked to conditions that affect the intestines, including inflammatory bowel disease, diverticulosis, irritable bowel syndrome, and intestinal infections. It may also be accompanied by abdominal pain and cramping.
Treatment for tenesmus should be managed by a gastroenterologist and depends on the underlying cause. Options may include medications, changes to diet and daily habits, and/or biofeedback (pelvic floor physical therapy).
Common symptoms
The main signs and symptoms of rectal tenesmus include:
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A sudden, urgent need to have a bowel movement, even when there is no stool to pass;
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A feeling of incomplete bowel emptying;
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Being unable to have a bowel movement despite a strong urge;
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Abdominal pain and cramping;
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Rectal pain.
Depending on the cause of tenesmus, other symptoms may also occur, such as fever, chills, blood in the stool, loss of appetite, nausea, and vomiting.
If symptoms indicate tenesmus, consult a gastroenterologist promptly to confirm the diagnosis, identify the underlying cause, and initiate the most effective treatment.
Rectal tenesmus vs vesical tenesmus
Rectal tenesmus is an intense urge to have a bowel movement with a lingering sensation that stool is still present in the rectum.
Vesical tenesmus involves the bladder and is described as a feeling of incomplete bladder emptying, even when the bladder is actually empty.
Possible causes
The main causes of rectal tenesmus include:
1. Inflammatory bowel disease
Inflammatory bowel diseases, such as ulcerative colitis or Crohn’s disease, can cause symptoms like bloating, fever, severe diarrhea, and tenesmus.
2. Intestinal infection
Intestinal infections caused by bacteria, viruses, or parasites can also lead to tenesmus. Other symptoms may include abdominal cramps and pain, diarrhea, loss of appetite, and fever in some cases.
3. Perianal abscess
A perianal abscess is a pus-filled pocket that forms in the skin around the anus. It can cause pain (especially during bowel movements or while sitting), a painful lump near the anus, bleeding, and yellowish drainage. Rectal tenesmus may also occur.
4. Rectal cancer
Rectal cancer can cause frequent diarrhea, blood in the stool, abdominal pain, or tenesmus. These symptoms can be hard to recognize because they may also occur with common problems such as intestinal infections or hemorrhoids.
5. Diverticulosis
Diverticulosis is a condition in which small pouches (diverticula) form in the lining of the intestine. They develop when weak spots in the intestinal wall bulge outward due to intestinal contractions. Diverticulosis usually does not cause symptoms unless the pouches become inflamed or infected, leading to diverticulitis.
6. Irritable bowel syndrome
Irritable bowel syndrome (IBS) is a bowel disorder that can cause abdominal pain, constipation or diarrhea, and, in some cases, tenesmus.
People with this condition are often more sensitive to triggers such as stress, diet, medications, or hormones, which can lead to abnormal intestinal contractions or changes elsewhere in the gastrointestinal tract.
Confirming a diagnosis
A gastroenterologist typically diagnoses tenesmus by reviewing the person’s symptoms and medical history. They may also ask about bowel habits, diet, and lifestyle factors.
To determine the cause of tenesmus, the doctor may order blood tests and stool tests. They may also recommend imaging such as a CT scan, along with procedures like colonoscopy or sigmoidoscopy.
Treatment options
Treatment for tenesmus should be managed by a gastroenterologist and varies depending on the cause. The doctor may prescribe anti-inflammatory medications or oral or rectal corticosteroids to reduce inflammation and help relieve symptoms.
If tenesmus is linked to an infection, antibiotics or antiparasitic medications may be used to treat the underlying infection and relieve symptoms.
The doctor may also recommend laxatives for people whose tenesmus is associated with constipation or intestinal motility problems, pain relievers to reduce discomfort, and avoiding foods that seem to trigger bowel symptoms.
Natural treatments
In addition to medical treatment, certain daily measures may help relieve or even resolve tenesmus. These include eating a balanced, high-fiber diet with vegetables, fruits, beans and lentils, seeds, and nuts, drinking plenty of water, and exercising regularly to support healthy bowel function and reduce stress.