Dealing With Incomplete Bowel Movements

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The feeling of incomplete evacuation—in other words, feeling like your bowel movement is incomplete—can be quite uncomfortable. In addition to the physical discomfort, incomplete bowel movements can cause you to feel quite worried about what is going wrong or when you will need to be back in the bathroom, especially if you notice a stark change from your normal bowel movements.

what is an incomplete bowel movement

Verywell / Cindy Chung

Incomplete evacuation is a hallmark symptom of irritable bowel syndrome (IBS), but you don't need to have IBS to experience this unpleasant symptom. Considering how common IBS is, it is remarkable how little attention the symptom of incomplete evacuation gets from researchers. As a result, not much is known about how you can resolve it.

Until research uncovers more about it, you'll need to explore medications, therapies, and self-care strategies that may help you manage and reduce your symptoms.

What Is Incomplete Evacuation?

Incomplete evacuation is a subjective sensation that a bowel movement has not been as complete as it should be. When you're constipated, the passage of small, hard stools may not leave you with the sense that you got everything out.

On the opposite side of the spectrum, people with chronic diarrhea may feel continued urges to defecate even after repeated bowel movements.

In addition to physical discomfort, IBS can cause psychological distress or anxiety. Some people may also isolate themselves to avoid having an IBS flare in public.

Why It Happens

Again, there is not much known about the reasons behind the phenomenon of incomplete evacuation. Two physiological processes that have been identified as major underpinnings of IBS symptoms may be playing a role here.

  1. Visceral hypersensitivity refers to a heightened pain sensitivity within internal organs—in this case, the large intestine, the rectum, and the anus.
  2. Motility dysfunction occurs when the muscles of the digestive tract aren't operating in a smooth manner and interfere with your ability to pass a comfortable, well-formed stool and feel as if you have had a complete bowel movement.

How Normal Bowel Movements Happen

In order to address the problem of incomplete evacuation, it's essential to know what a "complete evacuation" is supposed to be. 

  • Stool matter makes its way along the entire length of the large intestine.
  • Throughout this process, water is being absorbed from the stool, so that it becomes firmer as it makes its way through the bowel.
  • Typically, stool moves into the sigmoid colon and rectum once or twice a day (although this varies significantly from person to person).
  • There, it's formed into a sausage-like shape so it can be passed comfortably out through the anus.

Incomplete Evacuation With Constipation

If you have constipation, the sensation of incomplete evacuation is directly related to physiology. Due to the difficulty in passing stool, it is likely that you have not fully emptied the rectum of it, leaving you with feelings of dissatisfaction and discomfort.

To counteract this effect, your healthcare provider may prescribe medication to help the intestines pass stool along. You may also benefit from simple self-care strategies that can be tried at home, or other forms of therapy that relive symptoms by targeting the gut-brain connection.

Prescription Medications

The U.S. Food and Drug Administration (FDA) has approved two medications for treating IBS with constipation (IBS-C): Linzess (linaclotide) and Trulance (plecanatide). Both drugs are classified as guanylate cyclase activators, which target guanylate cyclase receptors in the intestines. That prompts an increase in intestinal fluid, which:

  • Keeps the stool softer
  • Helps reduce abdominal pain
  • Helps reduce stool frequency
  • Alleviates IBS symptoms

These drugs are considered safe and well-tolerated, with the most common side effect being mild to moderate diarrhea.

Although they are not indicated to treat IBS, tricyclic antidepressants are known to have a therapeutic effect on the gastrointestinal system. For this reason, healthcare providers may prescribe them off-label to treat IBS symptoms such as abdominal pain.

Tricyclic antidepressants help maintain serotonin levels in the gut, which reduces inflammation and promotes gut motility. Commonly prescribed tricyclic medications include:

  • Elavil (amitriptyline)
  • Tofranil (imipramine)
  • Norpramin (desipramine)
  • Aventyl (nortriptyline)

Both of these approaches are recommended by American College of Gastroenterology's (ACG) Clinic Guidelines for the management of IBS, which were published in January of 2021. Linzess and Trulance are recommended specifically for IBS-C while tricyclics are recommended for all IBS subtypes.

Self-Care Strategies

You can also try several self-care strategies at home to relieve the feeling of incomplete evacuation when you have IBS-C.

  • Consistent bowel habits: Many people have bowel movements in the morning and not so much at night. Pay attention to your own biorhythm and try to schedule a trip to the toilet around that same time each day.
  • Visualization: Allow your body the time to empty as much stool as is possible, envisioning that rectum shape as you evaluate the "completeness" of the movement.
  • Soluble fiber intake: Slowly increase your intake of foods that are rich in soluble fibers (not insoluble fiber) or try a psyllium-based fiber supplement. Foods high in soluble fiber include bananas, blueberries, kiwi, oranges, carrots, eggplant, green beans, oatmeal, zucchini, and potatoes with skin.

The ACG guidelines specifically state that insoluble fiber, in studies, has not been shown to improve IBS symptoms while soluble fiber has.

Adequate fiber intake is defined as 25 grams for adult women and 38 grams for adult men. If you're having trouble eating enough soluble fiber in your diet, consider including a fiber supplement to boost your intake.

Gut-Directed Psychotherapies

If you believe that dyssynergic defecation contributes to the difficulty in passing a complete stool, you may want to look into biofeedback or physical therapy as a way to ease your symptoms. Gut-directed psychotherapy is recommended by the ACG guidelines as it's been increasingly viewed as an effective complementary therapy for IBS.

The brain and the intestines are in constant communication with each other through the brain-gut axis. Therefore, the goal of gut-directed psychotherapy is to reduce the burden of gastrointestinal symptoms through coping strategies. In particular, cognitive behavioral therapy (CBT) directed at the gut-brain connection can teach muscle relaxation and breathing techniques to lower pain sensitivity and encourage the mind to better self-regulate gut motility.

Incomplete Evacuation With Diarrhea

The sensation of incomplete evacuation for people who experience chronic diarrhea is much more complex. Although known by the blanket term tenesmus, there's a glaring lack of research as to what causes this phenomenon when it occurs without any obvious physiological reason. Fortunately, effective therapies are available to aid with symptoms.

Prescription Medication

Xifaxan (rifaximin) is an FDA-approved antibiotic for treating IBS with diarrhea (IBS-D), and this treatment is backed by the ACG guidelines, as well.

Xifaxan stays active in your gastrointestinal tract but does not absorb⁠—a factor that contributes to its safety profile, as it's not likely to interact with other medications or become less effective over time. Side effects with rifaximin are mild and uncommon, but can include:

  • Diarrhea
  • Loss of taste
  • Anorexia
  • Nausea
  • Nasal irritation

Self-Care Strategies

Once stool emerges that is loose and watery, any firm stool that may have been residing in the sigmoid colon has certainly been passed. Yet, some nerve and motor dysfunction appear to be keeping the sensation of an urgency to empty very much alive. In order to counteract this sense of urgency, it helps to remind yourself that no further stool really needs to come out.

Keep in mind that there is no such thing as a truly empty bowel, as new stool is constantly being produced. In terms of the fear of future diarrhea episodes, remember that it is easier for the muscles of the anus to contain stool that is firm (i.e., has been "hanging out" and dried in the colon) than the watery stool that is emerging from higher up in the large intestine.

If you feel a constant urge to run to the toilet, try to delay yourself. Sit quietly in a spot near the bathroom and see if you can use relaxation exercises to calm your body until the sense of urgency passes without having to make another trip to the bathroom. Calming your body will also help to reduce any anxiety that might be causing the central nervous system to continue to send out impulses for further (unnecessary) emptying.

These coping mechanisms can be difficult at first, especially if you haven't had any previous guidance. Furthermore, IBS-D may make you stressed in social settings, leading to anxiety, isolation, and misinterpretation of digestive processes that are completely normal. As with IBS-C, gut-directed psychotherapy—like CBT—is recommended as a complementary therapy that improves IBS symptoms and the psychological distress that can accompany them.

A Word From Verywell

The exact cause of incomplete evacuation is not entirely clear, leaving many people who experience the sensation at a loss for how to improve their symptoms. If you've tried prescription medication, coping mechanisms, and psychotherapy without positive results, it's possible you may have another condition that resembles IBS, such as celiac disease or inflammatory bowel disease.

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9 Sources
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