Rectal tenesmus, or tenesmus, is a feeling of being unable to empty the large bowel, even if there is no remaining stool to expel.

Several medical conditions can cause tenesmus. These include inflammatory bowel disease (IBD), colorectal cancer, and disorders that affect how the muscles move food through the gut. It can be painful, especially if it presents with cramping or other digestive symptoms. The symptoms can come and go, or they may persist in the long term.

Vesical tenesmus is a separate condition that relates to the bladder. A person will feel as though they are unable to empty the bladder, even when there is no urine present.

In this article, we discuss the different types and symptoms of tenesmus and the treatment options.

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Tenesmus refers to a persistent and painful desire to evacuate the bowel, despite having an empty colon. It often involves cramping, involuntary straining, and the passage of little fecal matter.

The sensation is not a condition in itself but a symptom of other health issues that can affect the gastrointestinal system. These issues may include inflammatory conditions of the bowel or motility disorders that may affect the normal movements of the intestines.

Although the term tenesmus usually refers to rectal tenesmus, some people may also use the term vesical tenesmus. This instead describes the feeling of incomplete bladder emptying after passing urine.

Similar to rectal tenesmus, vesical tenesmus is a potential symptom of conditions that affect the bladder.

The type of treatment will depend on the severity of the tenesmus and its underlying cause.

Inflammatory bowel disease

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

Various drugs are available for relieving the symptoms of IBD, including tenesmus. Doctors may recommend:

  • Anti-inflammatory drugs: Oral or rectal medications can reduce inflammation and help achieve or maintain remission.
  • Immune system suppressors: These drugs can inhibit the immune system response that causes inflammation.
  • Corticosteroid therapy: Fast acting systemic steroids can help manage IBD flares by reducing inflammation.
  • TNF blockers: This type of immunosuppressant can target substances in the body that lead to inflammation.
  • Antibiotics: These can help destroy bacteria that may be causing symptoms or making them worse.
  • Pain relief: A person can use pain relief medication alongside other therapies.

In some cases, a doctor may recommend surgery to relieve the symptoms if medications have proven ineffective.

Learn more here about surgery for ulcerative colitis, a type of IBD.

Motility disorders

Any condition that causes the movement of food or waste through the digestive tract to speed up or slow down is an intestinal motility disorder. A person with a motility disorder may have diarrhea or constipation.

Diarrhea

If tenesmus results from infectious diarrhea, a doctor may prescribe antibiotics or antiparasitics, depending on the underlying cause.

If diarrhea results from certain foods or medications, they may recommend avoiding the trigger item. Examples of ingredients that can trigger diarrhea in some people include lactose, sorbitol, and caffeine.

Antidiarrheal agents, such as loperamide (Imodium), can help relieve symptoms.

Constipation

If tenesmus results from constipation, a laxative may help the stool pass through the colon more easily.

If constipation causes stool to become stuck, a blockage may result. This is known as fecal impaction. The doctor may remove the stool manually or flush it out using a rectal laxative enema or water irrigation.

Dietary changes can help with both constipation and diarrhea.

Learn more about treating constipation or diarrhea at home.

Colorectal cancer

Tenesmus can be a sign of a blockage due to a cancerous tumor.

The doctor may recommend a combination of surgery, chemotherapy, and radiation therapy, depending on the stage of the cancer and the person’s overall health. Removing the tumor will often relieve tenesmus.

Sometimes, after surgery, waste will not be able to pass through the large intestine. When this occurs, a person will require a colostomy bag.

It is not always possible to cure colorectal cancer. However, palliative care can help a person feel more comfortable while living with cancer.

Options for improving a person’s comfort and quality of life with cancer-related tenesmus include:

  • drug therapies
  • treatment to relieve pain
  • endoscopic laser interventions

These will not cure cancer, but they can help relieve symptoms.

Other causes

Tenesmus that results from a sexually transmitted infection (STI) should resolve when the person receives treatment for the infection.

The primary way to treat tenesmus is to manage the underlying problem that is causing it. A doctor can provide medical treatment, but home remedies and lifestyle adjustments may also help.

A balanced, high fiber diet

Consuming a diet that is high in fiber may help relieve tenesmus.

The 2020–2025 Dietary Guidelines for Americans recommend consuming up to 36 grams of fiber a day, depending on the person’s age, sex, and pregnancy status.

Fiber-rich foods include:

  • vegetables
  • fruits
  • whole grains
  • nuts and seeds

A low fiber diet

Fiber can make the symptoms worse for some people with IBD. When someone has a blockage in the colon, a doctor may recommend eating a low fiber diet.

A person should always talk with their doctor before making any significant dietary changes.

Water

A low intake of water and other fluids can lead to dehydration, which is a risk factor for constipation. Staying hydrated by drinking plenty of water will help keep the stool soft, making it easier to pass.

Learn more about the benefits of drinking water.

Physical activity

Regular exercise can help regulate activity in the intestines and encourage the body to establish a regular bowel movement schedule.

Stress management

If the underlying cause of tenesmus is IBD, taking steps to reduce stress may be beneficial. As IBD and its symptoms tend to flare up during periods of high stress, using techniques such as meditation, deep breathing exercises, and progressive muscle relaxation may help manage stress and prevent a flare.

Learn more about managing stress.

Rectal tenesmus, which refers to the frequent urge to have a bowel movement, is a symptom in itself. People may also experience other symptoms alongside it, including:

  • abdominal and rectal pain
  • rectal bleeding
  • nausea or vomiting
  • chills or fever

Rectal tenesmus can happen for several reasons. The most common cause is colon inflammation, which can result from a noninfectious or infectious cause.

IBD is one cause of colon inflammation. IBD is an umbrella term for several long-term conditions involving chronic inflammation of the gut. Ulcerative colitis and Crohn’s disease are common forms of IBD.

Experts do not know what causes IBD, but several factors may play a role. One theory is that the immune system mistakenly attacks the gastrointestinal tract. There may also be a genetic component.

IBD can cause inflammation and ulceration of the gastrointestinal tract, which can lead to narrowing or blocking of the gut and 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, such as with bacteria or a virus
  • ischemic colitis, an inflammation of the colon due to decreased blood flow to that area
  • diverticulitis, which occurs when there is inflammation of bulges in the wall of the colon
  • inflammation of the colon due to radiation
  • the abnormal movement of food or waste in the digestive tract
  • irritable bowel syndrome (IBS)
  • a prolapsed hemorrhoid
  • a rectal abscess
  • rectal gonorrhea
  • colorectal cancer

Tenesmus can also be a symptom of constipation or diarrhea. Various factors can cause these issues, including dietary choices.

Learn more about rectal pressure.

If a person has tenesmus, the doctor will carry out a medical assessment and physical examination to try to determine the cause.

The doctor will ask the individual about their personal and family medical history.

They will also ask about:

  • symptoms, including the duration, frequency, severity, and onset
  • bowel habits
  • diet and lifestyle
  • other health problems

The diagnostic process may also involve an abdominal and rectal examination.

Other tests may include:

  • blood tests
  • a stool culture
  • an X-ray or CT scan of the abdominopelvic area
  • a colonoscopy, which will show details of the inside of the colon
  • a sigmoidoscopy, to examine the last sections of the colon
  • screening for STIs

A person should consult a doctor when it is difficult or painful to pass stool, especially if the symptoms last more than a few days or are recurrent.

It is also important to speak with a doctor as soon as possible if the following symptoms occur:

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

Tenesmus is a sign of a bowel problem that may need medical treatment. There are many ways to relieve the symptoms, depending on the cause.

Anyone who experiences severe or persistent bowel discomfort should contact a doctor, as early treatment can often prevent a condition from getting worse.