Rectal Tenesmus Symptoms, Causes, and Treatment

The Sensation of Being Unable to Empty the Bowel

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Tenesmus is a medical term used to describe the feeling that you need to poop even though your bowels are empty. Tenesmus is not a disease on its own. Rather, it's a symptom of another medical problem.

Often, it's a sign of inflammatory bowel disease (IBD), but you may get the sensation with a variety of conditions, such as hemorrhoids, infections, and cancer.

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This article explains what tenesmus may feel like and the other symptoms that accompany the sensation. It discusses common causes, how the underlying condition may be diagnosed, and possible treatments that can resolve tenesmus.

Related Symptoms

The term tenesmus specifically refers to the sensation that you need to defecate (pass a bowel movement) when you don't. However, you may notice other symptoms that accompany tenesmus, such as:

  • Cramping
  • Straining to push stool
  • Rectal pain

The symptoms of tenesmus may be constantly present or may come and go.

Other problems that may occur with tenesmus, such as stomach pains and rectal bleeding, are usually related to the underlying condition that's making you to feel like you have to go to the bathroom.

When to Call a Doctor

Seek medical care right away if you experience tenesmus along with a high fever (over 100.4 F), chills, severe rectal bleeding, nausea, vomiting, or fainting.

Causes

Doctors don't fully understand why tenesmus occurs, but other conditions can cause changes to your body that lead to this uncomfortable and painful issue.

Nerve Problems

It's believed that inflammation in the bowel may affect the nerves that control the excretion of waste. When these nerves are overstimulated, they may send a signal to your brain saying there's still material in the bowel.

That can trigger the muscles in the gut that are used to push out feces. Those muscles contract, so your body thinks it needs to have a bowel movement, but really there's nothing in the colon.

Bowel Damage

Another possible cause of tenesmus is scarring in the bowel brought on by severe diarrhea or constipation. When this scar tissue builds up, it makes it difficult to pass stool.

It may also cause you to feel as if there's more in the bowel than there actually is. Sores or growths around the rectum or in the colon can do the same.

Conditions

Tenesmus is, essentially, a sign that your digestive system is not functioning properly. Nerve issues, inflammation, scarring of the bowel, and other problems that affect digestion and excretion are caused by a number of conditions.

The following are some common disorders that can lead to tenesmus:

Radiation therapy for cervical cancer, rectal cancer, prostate cancer, or colon cancer can also cause damage and inflammation in the rectum. This can result in tenesmus as well as other symptoms such as diarrhea and pain.

Recap

Tenesmus is a symptom of a medical condition; it's not a disease or disorder on its own. This feeling of needing to have a bowel movement is often accompanied by cramping, pain, and other symptoms of the underlying cause. IBD is often at the root of tenesmus, but other disorders can also cause it.

Diagnosis

Your doctor may recommend you see a specialist who can diagnose the cause of your tenesmus. The first step is to review your medical history, family history, and current symptoms. You should be prepared to answer questions about your bowel habits, diet, and lifestyle.

Next, your doctor will conduct further tests to find the underlying reason for your symptoms.

Physical Exam

The physical exam is essential to the diagnosis of tenesmus. It helps your doctor see if there's any inflammation or abnormalities around the rectum, tenderness or pain in the abdomen, or signs of a sexually transmitted infection (STI).

The exam may involve a digital rectal exam (DRE). This involves the insertion of a gloved finger into the anus to check for hemorrhoids, blood, mucus discharge, infection, or abnormal growths.

Lab Tests

After the physical exam, your doctor will commonly order a number of blood and stool tests to help narrow down the causes.

These may include:

Imaging Studies

Before proceeding to more invasive procedures, your doctor may order imaging tests to help visualize your digestive tract.

These may include:

  • Barium X-ray: A type of X-ray in which a barium enema is used to highlight growths, obstruction, lesions, or perforation (a hole) in the intestine
  • Computed tomography (CT) colonography: An imaging technique involving multiple X-rays that visualize the intestines in detail, including the presence of polyps or tumors
  • Magnetic resonance imaging (MRI): A type of scan using powerful magnetic and radio waves to create highly detailed images of soft tissues within the digestive tract

Procedures

If colorectal cancer is suspected or something unusual is spotted on imaging studies, your doctor may refer you to a gastroenterologist, who specializes in digestive tract conditions.

You may also need some additional tests to confirm any diagnosis:

  • Colonoscopy: A procedure using a flexible scope, called a colonoscope, to examine the entire colon
  • Sigmoidoscopy: A version of colonoscopy limited to the lower part of the colon, called the sigmoid colon
  • Colon biopsy: Performed during a colonoscopy or sigmoidoscopy to obtain a sample of tissue for evaluation

If colorectal cancer is the cause of tenesmus, the only test that can definitively confirm the diagnosis is a biopsy. Blood tests and imaging studies can support the diagnosis, but they cannot diagnose the disease.

Recap

See your doctor whenever you have tenesmus or other symptoms related to bowel disease. Your doctor may recommend you see a gastroenterologist. The process of diagnosing the underlying health problem may involve a physical exam, blood tests, X-ray, MRI, colonoscopy, or a biopsy of colon tissue. 

Treatment 

Tenesmus tends to improve once the underlying cause is identified and treated. Because the causes of tenesmus are so diverse, so are the treatments. Below are the treatments used for the conditions that cause tenesmus.

Cause Treatment Options
Celiac disease Gluten-free diet
Constipation Laxatives and stool softeners
  High-fiber diet
Diarrhea Antidiarrheals like Imodium (loperamide)
Colorectal cancer Surgery
Radiation
  Chemotherapy, immunotherapy, and/or targeted therapy
Crohn's disease and Ulcerative Colitis Corticosteroids like prednisone
  Immunosuppressants like methotrexate
  Aminosalicylates like Colazal (balsalazide)
  TNF blockers like Humira (adalimumab)
  Antibiotics like Flagyl (metronidazole)
  Surgery
Diverticular disease High-fiber diet
  Oral or intravenous antibiotics
  Surgery
Gastroenteritis Antibiotics (if the cause is bacterial)
  Antiparastic drugs (if the cause is parasitic)
IBS High-fiber diet 
  Antispasmodics like Levsin (hyoscyamine)
  Anti-diarrheals or laxatives, as needed
  Tricyclic antidepressants like amitriptyline 
Ischemic colitis Antibiotics
  Surgery, if blood flow obstruction is severe
Pelvic floor disorders Stool softeners
  Physical therapy
  Percutaneous tibial nerve stimulation (PTNS)
  Surgery
Prolapsed hemorrhoid Rubber band ligation
  Sclerotherapy
  Hemorrhoidectomy
Rectal abscess Surgical drainage
  Antibiotics, including penicillin
Rectocele Kegel exercises
  Intravaginal pessary
  Surgery
STIs Antibiotics (varies by infection)

Summary

Tenesmus is the sensation of needing to have a bowel movement even when your colon is empty. Depending on the underlying cause, it may be accompanied by other symptoms like cramping, pain, and rectal bleeding.

The causes can range from relatively harmless, such as diarrhea or constipation, to serious, such as cancer. To determine the cause, a healthcare provider will do a physical exam, which may include a digital rectal exam. Blood tests, imaging tests, and procedures like a colonoscopy and biopsy may also be needed.

Once the cause is identified, the underlying condition needs to be treated in order for your tenesmus to go away. Many of these conditions require a change in diet, medication, or surgery to help relieve the symptoms.

A Word From Verywell

While you may feel uncomfortable discussing tenesmus with your doctor, it's important to do so. This is especially true if the symptom is persistent, worsening, or accompanied by bleeding, tarry stools, narrow stools, weight loss, fever, vomiting, or the inability to defecate. None of these symptoms should ever be dismissed or ignored.

Frequently Asked Questions

  • Why do I have a constant urge to poop?

    Tenesmus is the medical term for a constant or frequent feeling that you need to poop. even after having a bowel movement.

  • Is pain a common symptom of rectal tenesmus?

    Yes, rectal pain is a common symptom of rectal tenesmus. It may be constant or only appear on occasion. Other symptoms include gas, bloating, itching, rectal discharge, rectal bleeding, and severe straining.

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9 Sources
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