Tenesmus: Symptoms, causes, and treatment

Rectal tenesmus is a feeling of being unable to completely empty the large bowel of stool, even if there is nothing left to expel.

Commonly known simply as tenesmus, it is associated with several medical conditions. These include inflammatory bowel disease (IBD) and disorders that affect how muscles move foods through the gut.

Tenesmus can be painful, especially if accompanied by involuntary straining, cramping, or other digestive symptoms. These symptoms may come and go, or persist long-term.

A separate condition called vesical tenesmus is related to the urinary bladder. It is experienced as feelings of being unable to completely empty the bladder, despite possibly there being no urine present.

Contents of this article:

  1. Causes and risk factors
  2. Diagnosis
  3. When to see a doctor
  4. Treatment
  5. Management options

Causes and risk factors

Man holding stomach in pain.
Possible causes of tenesmus include an inflammation of the colon, colorectal cancer, and irritable bowel syndrome.

There are several potential reasons why someone would experience rectal tenesmus, the most common being colon inflammation, either from a noninfectious or infectious cause.

An example of colon inflammation is inflammatory bowel disease (IBD). IBD is an umbrella term for a number of long-term conditions involving chronic inflammation of the gut.

It affects up to 1.6 million Americans, according to the Crohn’s and Colitis Foundation, with ulcerative colitis and Crohn’s disease being the most common forms of IBD.

The cause of IBD is not known. Many experts believe that several factors may play a role, including the immune system abnormally attacking the gastrointestinal (GI) tract, and possibly a genetic component.

The inflammation and ulceration of the GI tract associated with IBD can lead to narrowing, blocking, perforation, or scarring of the bowel wall. These changes make it more difficult to pass stool and contribute to the development of tenesmus.

Other conditions associated with tenesmus include:

  • colon infection
  • colorectal cancer
  • diverticular disease
  • inflammation of the colon due to radiation
  • abnormal movement of food or waste in the digestive tract
  • irritable bowel syndrome
  • prolapsed hemorrhoid
  • rectal abscess
  • rectal gonorrhea

Diagnosis

A complete medical assessment and physical examination will be carried out to diagnose tenesmus and to identify its cause. Serious underlying causes, such as cancer or IBD, need to be found promptly, as early intervention is key to recovery and management.

The doctor will take a person’s complete medical and family histories, and will ask a variety of questions about:

  • symptoms, such as duration, frequency, severity, and onset
  • bowel habits
  • diet and lifestyle
  • other health problems

A detailed abdominal examination and a rectal examination will also be done.

Other tests that may be carried out include:

  • blood tests
  • a stool culture
  • X-ray plain film or CT scan of the abdominopelvic area
  • colonoscopy, to examine the entire colon
  • sigmoidoscopy, to examine the last sections of the colon
  • screening for sexually transmitted diseases

When to see a doctor

A person should see a doctor when it is difficult or painful to pass stool. It is especially important if the symptoms persist beyond a few days or are recurrent.

Prompt medical treatment should be sought if other symptoms associated with IBD or other potentially severe bowel conditions are experienced, including:

  • blood in the stool
  • chills
  • fever
  • nausea
  • vomiting
  • abdominal pain

Treatment

Treatment depends on the severity of the tenesmus and its underlying cause. According to a 2017 review of the research on tenesmus in people with cancer, using a combination of treatments may be needed to help manage symptoms.

Inflammatory bowel disease

Treatment for IBD aims to relieve discomfort, achieve and maintain remission of symptoms, and avoid any complications. Medications and surgery are the most common options.

Drugs that are available for relieving the symptoms of IBD, including tenesmus, include:

  • Anti-inflammatory drugs: Taken orally or rectally to reduce inflammation and help achieve or maintain remission.
  • Immune system suppressors: To inhibit the immune system response that causes inflammation.
  • Corticosteroid therapy: Fast-acting systemic steroids for the management of IBD flare-ups by causing immunosuppression and reducing inflammation.
  • Biologic therapy: Another subclass of immunosuppressants, such as a monoclonal antibody, that targets substances in the body that lead to inflammation.
  • Antibiotics: Used against bacteria that may be causing symptoms or making them worse.
  • Laxatives: Prescribed for those with tenesmus linked to constipation.
  • Pain relief: Symptoms that cause severe pain may be treated with pain relievers. These can be in addition to other medications for the cause of the pain and tenesmus.

Surgical procedures can be used to widen a narrow bowel or to remove blockages that are causing tenesmus and other IBD symptoms.

Motility disorders

Any abnormal movement of food or waste in the digestive tract may be considered an intestinal motility disorder. Diarrhea and constipation are the two most obvious signs of abnormal bowel motility.

Tenesmus that is associated with infectious diarrhea may be treated with antibiotics or anti-parasitics to kill an underlying bacterial or parasitic infection. If certain foods or medications are causing diarrhea, a doctor may recommend that a person avoids these.

Constipation that causes tenesmus may be treated with a laxative so the stool can pass through the colon more easily.

Impacted stool, where waste becomes stuck in the colon, may be manually removed by a doctor or flushed out with a rectal laxative enema or water irrigation.

Treatment for other causes

Tenesmus that is caused by other medical conditions, such as cancer or a sexually transmitted infection, may resolve once the underlying illness is effectively treated.

Doctors will tailor treatment plans based on the unique needs of every individual.

Management options

High fibre / fiber foods.
A diet with lots of high-fiber foods, such as fruit, whole grains, and nuts, may help to treat tenesmus.

In cases of tenesmus, managing the underlying disorder or cause is key to resolving this condition.

Some at-home treatments and lifestyle changes can help many people with tenesmus, inflammatory bowel disease, and motility issues.

These management techniques are also effective at helping to prevent tenesmus. They include:

A balanced high-fiber diet

Many people find that a diet high in fiber is an easy and effective way to relieve tenesmus, especially if it is linked to constipation.

The European Food Safety Authority recommends a minimum of 25 grams a day of dietary fiber for normal bowel function in adults. Fiber-rich foods include:

  • beans and lentils
  • vegetables
  • fruits
  • whole grains
  • nuts and seeds

Conversely, some people with IBD find that their symptoms get worse with high levels of fiber in their diet. This reaction is particularly the case if they have an acute flare-up or severe narrowing inside the bowel. It is important for people to discuss individual needs with a doctor before making any dietary changes.

Water

Not drinking enough water and other fluids is known to cause dehydration, a risk factor for constipation. Staying hydrated with water will help keep the stool soft, making it easier to pass.

Physical activity

Staying active can help to regulate activity in the intestines and help your body to establish a regular bowel movement schedule.

Stress management

IBD and its symptoms tend to flare up during periods of high stress. Managing stress may help keep symptoms of this condition at bay, or it may even help to maintain remission of IBD.

Techniques such as meditation, deep breathing exercises, and progressive muscle relaxation are all effective stress management tools.

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