Dealing With Incomplete Bowel Movements

Understanding the Causes and Treatment Options

The feeling of incomplete evacuation—meaning the sensation that a bowel movement is incomplete even when it is—can be uncomfortable and frustrating. In addition to the physical discomfort, incomplete evacuation can interfere with your quality of life if you are always heading to the bathroom or feel the need to be close to a bathroom.

what is an incomplete bowel movement

Verywell / Cindy Chung

Incomplete evacuation is a hallmark of irritable bowel syndrome (IBS), but other things can cause it as well. Fortunately, there are ways to deal with this aggravating and surprisingly common symptom.

This article explains why incomplete evacuation occurs and outlines the various pharmaceutical, self-care, and psychotherapy treatment options.

What Is Incomplete Evacuation?

Incomplete evacuation is the sensation that a bowel movement has not been complete even if it has. This is not an uncommon symptom affecting people with chronic (frequent or persistent) constipation or chronic diarrhea.

When you're chronically constipated, the passage of small, hard stools can make the rectum, anus, and colon extra-sensitive. The same can occur with chronic diarrhea, particularly when you are straining. There may also be uncontrollable clenching sensations that can occur even when no stools are present.

There are two mechanisms that are thought to underpin incomplete evacuation in people with constipation-predominant IBS (IBS-D) and diarrhea-predominant IBS (IBS-C):

  • Visceral hypersensitivity refers to a heightened pain sensitivity within internal organs—in this case, the large intestine, the rectum, and the anus.
  • Motility dysfunction occurs when the muscles of the digestive tract aren't operating normally, which interferes with your ability to pass a comfortable, well-formed stool.

Straining during diarrhea or constipation can also lead to hemorrhoids, which can also cause tenderness and a feeling that "something is up there" in the rectum.

Recap

Incomplete evacuation is common in people with chronic constipation or chronic diarrhea. Both can cause hypersensitivity and involuntary contractions of the colon, rectum, and anus.

Incomplete Evacuation With Constipation

If you have constipation, the sensation of incomplete evacuation may be accurate. Due to the difficulty in passing stool, it is likely that you have not fully emptied the rectum, 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 Food and Drug Administration (FDA) has approved two medications for treating IBS-C: Linzess (linaclotide) and Trulance (plecanatide). Both drugs are classified as guanylate cyclase activators, which target 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 approved specifically 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. Motility refers to the movement of food and stool through the intestines.

Commonly prescribed tricyclic medications include:

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

Both of these approaches are recommended by the American College of Gastroenterology's (ACG) clinical 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.

  • Bowel retraining: 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 possible, envisioning an empty rectum as you evaluate the "completeness" of the movement.
  • Soluble fiber intake: Slowly increase your intake of foods that are rich in soluble fibers (but 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. Insoluble fiber is found in foods like wheat bran and vegetables.

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 Psychotherapy

Dyssynergic defecation is a problem with the function of the nerves and muscles used to pass stool. If you believe you have this problem, 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 goal of gut-directed psychotherapy is to reduce gastrointestinal symptoms through coping strategies.

In particular, cognitive behavioral therapy (CBT) can teach muscle relaxation and breathing techniques to lower pain sensitivity and encourage the mind to better regulate gut motility.

Recap

The treatment of incomplete evacuation in people with IBS-C may involve a high-fiber diet, bowel retraining, gut-directed psychotherapy, and pharmaceutical drugs like Linzess, Trulance, and tricyclic antidepressants.

Incomplete Evacuation With Diarrhea

The sensation of incomplete evacuation for people who experience chronic diarrhea is much more complex. Although it's known by the blanket term tenesmus, there's a 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 is not absorbed⁠—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

If you pass stool that is loose and watery, it's likely that any firm stool that was in the colon has already passed. Yet, nerve and muscle dysfunction can make it feel like you still need to empty your bowel.

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 than watery stool that isn't ready to pass yet.

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 nervous system to continue to send out signals for further (unnecessary) emptying.

As with IBS-C, gut-directed psychotherapy such as CBT is recommended as a complementary therapy that improves IBS symptoms and the distress that can accompany them.

Recap

The treatment of incomplete evacuation in people with IBS-C may involve relaxation techniques to retrain how you respond to the uncomfortable sensation. The FDA-approved drug Xifaxan can help improve IBS-C symptoms along with gut-based psychotherapy.

Summary

Incomplete evacuation, the sensation that a bowel movement is not complete, is common in people with chronic constipation and chronic diarrhea, particularly those with irritable bowel syndrome (IBS). Both can cause the anus, rectum, and colon to become hypersensitive and lead to contractions that feel like the start of a bowel movement.

In people with constipation-predominant IBS (IBS-C), treatment options include a high-fiber diet, bowel retraining, gut-directed psychotherapy, and pharmaceutical drugs like Trulance and Linzess. In people with diarrhea-predominant IBS (IBS-D), options include bowel retraining, gut-directed psychotherapy, and the antibiotic Xifaxan.

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.

Was this page helpful?
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Choi YJ, Kim N, Yoon H, et al. Overlap between irritable bowel syndrome and functional dyspepsia including subtype analyses. J Gastroenterol Hepatol. 2017 Feb;32(9):1553-1561. doi:10.1111/jgh.13756

  2. Farzaei MH, Bahramsoltani R, Abdollahi M, Rahimi R. The role of visceral hypersensitivity in irritable bowel syndrome: Pharmacological targets and novel treatments. J Neurogastroenterol Motil. 2016 Oct;22(4):558-574. doi:10.5056/jnm16001

  3. Vahora IS, Tsouklidis N, Kumar R, Soni R, Khan S. How serotonin level fluctuation affects the effectiveness of treatment in irritable bowel syndrome. Cureus. 2020 Sep;12(8):c36. doi:10.7759/cureus.c36

  4. Dahl W, Stewart M. Position of the Academy of Nutrition and Dietetics: Health implications of dietary fiber. JAND. 2015 Nov;115(11):1861-1870. doi:10.1016/j.jand.2015.09.003

  5. Rao SS, Patcharatrakul T. Diagnosis and treatment of dyssynergic defecation. J Neurogastroenterol Motil. 2016 Jul;22(3):423-435. doi:10.5056/jnm16060

  6. Riehl M. The emerging role of brain-gut therapies for irritable bowel syndrome. Gastroenterol Hepatol. 2018 Jul;14(7):436-438.

  7. Bharucha AE, Seide BM, Zinsmeister AR, Melton LJ. Insights into normal and disordered bowel habits from bowel diaries. Am J Gastroenterol. 2008;103(3):692-8. doi:10.1111/j.1572-0241.2007.01631.x

  8. Karuppiah S, Pomianowski K. Rifaximin (Xifaxan) for irritable bowel syndrome. Am Fam Physician. 2017 Feb 15;95(4):258-259.

  9. Kinsinger SW. Cognitive-behavioral therapy for patients with irritable bowel syndrome: current insightsPsychol Res Behav Manag. 2017 Jul;10(1):231-237. doi:10.2147/PRBM.S120817

Additional Reading