Tenesmus: Causes, Diagnosis, and Treatments for the Troubling Symptom

What is Tenesmus?

Tenesmus refers to a feeling of incomplete bowel evacuation and urgent need to pass stool, even when the bowels are empty. It may involve:

• Rectal pain or discomfort
• Straining or inability to fully empty the bowels
• Frequent, small stools
• Constant urge to have a bowel movement

In some cases, small amounts of blood or mucus may also be passed with stool. Episodes of tenesmus tend to be sporadic, coming and going.

What Causes Tenesmus?

Tenesmus has a wide range of possible underlying causes. Some of the most common include:

Inflammatory Bowel Diseases

Chronic conditions like Crohn's disease or ulcerative colitis cause inflammation and ulcers along the digestive tract. This can lead to abdominal pain, diarrhea, rectal irritation and tenesmus.

Infections

Viral, bacterial, or parasitic gut infections can result in inflammation, ulcers, and irritation of the rectum and anus. Common culprits include salmonella, shigella, campylobacter, C. difficile, giardia, and crypto.

Diverticulitis

Infection or inflammation of small pouches called diverticula that form in the intestinal wall is a prime cause of tenesmus, especially in older adults. It also causes pain, fever, nausea, constipation or diarrhea.

Anal Fissures

These small tears in the thin tissue lining the anus are a common cause of painful, difficult bowel movements and bleeding. Fissures are often accompanied by persistent urges to defecate.

Hemorrhoids

Enlarged, swollen veins in the anus and lower rectum can cause bleeding, itching, discomfort, and tenesmus, especially when inflamed. Chronic straining aggravates them.

Rectal Prolapse

Rectal prolapse is when the rectum loses support and falls slightly through the anus. This can cause a feeling of rectal fullness and incomplete evacuation after bowel movements.

Rectal Cancer

While rare, rectal tumors can obstruct bowel movements, cause bleeding, abdominal cramps, and constant urges to defecate with little result.

Pelvic Radiation

Radiation therapy for pelvic cancers can damage healthy tissue, leading to inflammation, scarring, and narrowed rectal passages. This increases tenesmus risk.

Certain Medications

Some drugs like certain opioids, antipsychotics, antidepressants, blood pressure medications, and iron supplements may cause constipation and straining, increasing tenesmus likelihood.

When to See a Doctor

Contact your doctor if you experience:

• Frequent tenesmus with no known cause
• Difficult or painful bowel movements
• Blood in stool
• Unexplained weight loss
• Fever over 101F
• Persistently abnormal bowel habits

While tenesmus itself is not life-threatening, identifying and properly treating any serious underlying condition causing it is essential.

Diagnosing the Cause of Tenesmus

To pinpoint why tenesmus is occurring, doctors utilize:

Medical History

Your doctor will ask about your symptoms, bowel habits, diet, medications, and any prior digestive conditions or surgeries.

Physical Exam

Examining your abdomen for tenderness, listening for bowel sounds, and performing a digital rectal exam aids diagnosis.

Blood and Stool Tests

These check for signs of inflammation, infection, bleeding, or cancer markers that could indicate a cause.

Colonoscopy

This procedure uses a lighted camera on a flexible tube to visibly inspect the full rectum and colon. It can detect inflammation, tumors, hemorrhoids, etc.

Imaging Tests

CT scans, MRIs, or X-rays allow examination of the intestinal tract for abnormalities pointing to potential causes.

Manometry

Measuring muscle contractions and rectal sensitivity helps assess rectal function.

Treatments for Tenesmus

Relieving tenesmus involves treating any identified underlying condition, as well as making dietary changes to ease symptoms. Treatment approaches may include:

Medications

• Antibiotics for infections
• Anti-inflammatories like mesalamine for IBD
• Stool softeners or laxatives for constipation
• Pain relievers
• Suppositories, ointments, or creams to soothe anal irritation

Dietary Changes

• Increased fiber and water intake
• Avoiding dairy, greasy foods, alcohol, caffeine
• Low residue, low fiber diets for acute flare ups

Surgery

• Hemorrhoid removal
• Removal of affected bowel sections for Crohn's, ulcerative colitis, or cancer
• Repair of rectal prolapse
• Diverting ostomy to rest the rectum and anus

Treating the underlying condition is key to resolving tenesmus. Mild cases may resolve with conservative symptom management.

Coping with Recurring Tenesmus

For chronic or recurring tenesmus not fully resolved with treatment, coping strategies include:

• Avoid straining during bowel movements
• Warm baths to soothe anal sphincter muscles
• Donut or pillow cushions when sitting
• Relaxation techniques
• Following an IBS-friendly diet
• Keeping a food/symptom journal to identify triggers
• Seeking emotional support

Discuss any persistent tenesmus with your doctor to explore additional medication or surgical options for relieving discomfort.

When to Seek Emergency Care

Seek emergency medical care if you experience:

• Intense rectal pain
• Fever over 102F
• Dizziness, rapid heart rate, dehydration
• Large amounts of blood in stool
• Inability to pass any stool or gas

These signs can indicate a severe underlying problem needing urgent treatment such as a bowel obstruction, perforation, or systemic infection.

Outlook for Tenesmus

While troubling, tenesmus usually resolves once any underlying condition is properly diagnosed and treated. Typical outlooks depend

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.