Tenesmus: Causes, Symptoms, Treatment

Tenesmus is a feeling of an urgent need to pass stool even while the bowels are empty. There is straining and discomfort during the bowel movement, producing a small amount of stool.⁽¹⁾ The symptoms of tenesmus may come and go and may even persist for the long term.

Vesical tenesmus is a separate condition that affects the urinary bladder. A person with this condition feels an inability to empty the bladder even when there is no urine in the bladder.

There are numerous causes of tenesmus, the most common being inflammation due to infectious and non-infectious reasons. There are several causes of colon inflammation, inflammatory bowel disease being the most common. Ulcerative colitis and Crohn’s disease are the most common form of inflammatory bowel disease.

Inflammatory bowel disease can lead to inflammation and scarring of the gastrointestinal tract. This leads to narrowing or blocking of the gut and perforation of the bowel wall. This further leads to difficulty in passing stool and contributes to the development of tenesmus.

Other causes of tenesmus include:

• Colon infection that is caused by bacteria and virus
• Ischemic colitis, which is the inflammation of the colon due to decreased blood.
• Diverticulitis, which occurs due to inflammation of the wall irritable bowel syndrome of the colon.
• Prolapsed hemorrhoid
• Colorectal cancer
• Rectal gonorrhea
• Abnormal movement of food and waste in the digestive tract.

Tenesmus can also be a symptom of diarrhea and constipation, which have numerous causes including dietary choices.

The symptoms of tenesmus include:

• A frequent urge to pass stool
• Passing stool in very less quantity
• A feeling of unsatisfactory stool evacuation
• Excessive straining and discomfort during stool

A person with tenesmus has a feeling to pass stool even if the bowels are empty. There may be cramping and discomfort.

A person may have to strain excessively to pass a small amount of stool.

To diagnose tenesmus, a doctor performs a physical examination. The medical history is taken to find out if there is a symptom of weight loss or blood in the stool.

There are a few tests that can be performed to diagnose tenesmus, which include:

• Endoscopy
• Colonoscopy
• Imaging studies like radiographs, magnetic resonance imaging, and computed tomography
• Blood test
• Anorectal manometry
• Stool assessment

The treatment for tenesmus depends on the underlying condition of which it is a symptom.

Tenesmus can be relieved by following some dietary and lifestyle changes.

High Fiber Diet: Eating a high fiber diet can help relieve tenesmus that occurs due to constipation or inflammatory bowel disease. Fiber makes the stool softer and adds weight to it. This helps it pass easily.

Sometimes high fiber food can trigger the symptoms of inflammatory bowel disease. It is therefore important to consult a doctor to identify trigger foods. In such cases, doctors may recommend low-fiber food.⁽²⁾

Drink Water: Drinking plenty of water helps as it can soften the stool.

Physical Activity: Being physically active stimulates the movement of the intestines. It can help in the tenesmus by helping the intestine move the waste through the gastrointestinal tract.

Medical treatment depends on the cause of the tenesmus.

Inflammatory Bowel Disease: It can be treated with anti-inflammatory medications, medications that reduce the immune system activity, and antibiotics.

Infections: If tenesmus is caused by infection, antibiotics are used to treat it.

Constipation: If constipation is the reason for tenesmus, stool softeners, laxatives, and fiber supplements are used.

Rectal Prolapse: Research conducted in 2015 suggested tricyclic antidepressants may be effective in treating tenesmus in people with rectal prolapse.⁽³⁾

It is important to see a doctor if passing stool gets too difficult or painful and the symptoms are lasting for more than a few days.

A doctor should be seen as soon as possible if there is:

• Blood in stool
• Abdominal pain
• Nausea and vomiting
• Chills and fever

Tenesmus can be a sign of several health issues and if experiencing this symptom frequently, it is recommended to consult a doctor.