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Rectal tenesmus, or tenesmus, is a feeling of being unable to empty the large bowel of stool, even if there is nothing left to expel.
Several medical conditions can cause tenesmus. These include inflammatory bowel disease (IBD), colorectal cancer, and disorders that affect how muscles move food through the gut.
It can be painful, especially if there is cramping or other digestive symptoms. The symptoms can come and go, or they may persist long term.
Vesical tenesmus is a separate condition that relates to the urinary bladder. A person will feel as if they are unable to empty the bladder, even when there is no urine present.
Rectal tenesmus can happen for several reasons. The most common is colon inflammation, either from a noninfectious or infectious cause.
Inflammatory bowel disease (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 (GI) tract. There may also be a genetic component.
IBD can lead to inflammation and ulceration of the GI 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, which can be caused by organisms, such as a bacteria or virus
- ischemic colitis, an inflammation of the colon due to decreased blood flow to that area
- diverticulitis, caused by 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
What causes rectal pressure? Click here to find out.
If a person has tenesmus, the doctor will carry out a medical assessment and physical examination to try to find the cause.
The doctor will ask the individual about their personal and family medical history.
They will also ask about:
- symptoms, such as duration, frequency, severity, and onset
- bowel habits
- diet and lifestyle
- other health problems
The doctor will also carry out an abdominal and rectal examination.
Other tests may include:
A person should see a doctor when it is difficult or painful to pass stool, especially if the symptoms last more than a few days or are recurrent.
People should also see their doctor as soon as possible if they have:
- blood in the stool
- chills and a fever
- nausea and vomiting
- abdominal pain
Treatment depends 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.
Drugs for relieving the symptoms of IBD, including tenesmus, include:
Anti-inflammatory drugs: Oral or rectal medications can reduce inflammation and help achieve or maintain remission.
Immune system suppressors: These 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: Another type of immunosuppressant, such as a monoclonal antibody, can target substances in the body that lead to inflammation.
Antibiotics: These can help defeat bacteria that may be causing symptoms or making them worse.
Laxatives: These can help if tenesmus results from constipation.
Pain relief: A person can take pain relief medication alongside other therapies.
In some cases, a doctor may recommend surgery to relieve symptoms after medications failed to do so.
Learn more here about surgery for ulcerative colitis, a type of IBD.
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 anti-parasitics, 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, sucrose, and caffeine.
Antidiarrheal agents, such asLoperamide (Imodium), can help relieve symptoms.
Laxatives: If tenesmus results from constipation, a laxative may help the stool pass through the colon more easily.
If constipation causes stool to become impacted, a blockage may result. The doctor may remove the stool manually or flush it out with a rectal laxative enema or water irrigation.
Dietary changes can help with both constipation and diarrhea.
Get some tips on treating constipation at home.
Find out how to treat diarrhea at home.
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 need to have a colostomy. Find out more about what this involves here.
It is not always possible to cure colorectal cancer. 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.
Tenesmus that results from a sexually transmitted infection 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 help with medical treatment, but home remedies and lifestyle changes may also help.
A balanced high fiber diet
Consuming a diet that is high in fiber may help relieve tenesmus.
The 2015–2020 Dietary Guidelines for Americans recommend consuming up to 33.6 grams (g) of fiber a day, depending on the person’s age and sex.
Fiber-rich foods include:
- whole grains
- nuts and seeds
A low-fiber diet
Fiber can make symptoms worse for some people with IBD.
When someone has a blockage in the colon, a doctor may recommend a low fiber diet.
Find out more here about what to eat and what to avoid on a low-fiber diet.
People should talk to their doctor before making any significant dietary changes.
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.
Regular exercise can help regulate activity in the intestines and encourage the body to establish a regular bowel movement schedule.
IBD and its symptoms tend to flare up during periods of high stress. Managing stress may help prevent a flare.
Techniques such as meditation, deep breathing exercises, and progressive muscle relaxation can all help manage stress.
Why does stress happen, and how can you manage it? Find out here.
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 see a doctor, as early treatment can often prevent a condition from getting worse.
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How soon should I see a doctor if I have this feeling that I can’t empty my bowels?
The simple answer is that anyone who has trouble emptying their bowels should see the doctor as soon as possible.
At the very least, call the doctor with any questions, and they can help determine how quickly the individual should make an appointment. Tenesmus can stem from a wide range of medical conditions.
So, it is safer to see a doctor as soon as possible, so that they can determine if they need to do any further workup.Kevin Martinez, M.D. Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.