Definition, types, treatment, symptoms, and more

Tenesmus is a feeling of being unable to empty the bowel or bladder. It usually refers to rectal tenesmus, which can occur with inflammatory bowel disease (IBD), rectal cancer, and other conditions.

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.

Rectal tenesmus is when a person still feels the need to poo, although there is no more stool to remove. 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.

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

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, such as inflammatory bowel disease (IBD) 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.

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Content updated on Jan 4, 2023

About the symptom

Sense of fecal retention describes the feeling of discomfort in the body due to gastrointestinal pressure from waste buildup, which is the result of constant constipation when poop is stuck inside of the rectum.

When to see a doctor

Seek professional care if you experience any of the following symptoms

Possible causes

• Descent of uterus / uterine prolapse

  The uterus (womb) protrudes outside the body when the muscles and tissues supporting it become weakened, such as after repeated childbirths or aging, causing the womb to drop out.

• Colon cancer

  Cancer of the large intestine. It can be easily treated in the early stage, so the general population is encouraged to get screened with stool blood tests and colonoscopy (camera screening).

• Rectal cancer

  Rectal cancer is a type of cancer that starts in the rectum. Malignant, or cancerous cells, form in the rectal tissue and can spread to other parts of the body.

• Irritable bowel syndrome (IBS)
• Neurogenic intrapelvic syndrome

Questions your doctor may ask about this symptom

Your doctor may ask these questions to check for this symptom

• Do you feel like you have not completely emptied your bowels?

• Do you have a fever?

• Do you have hard stools or constipation recently?

• Is there blood in your stool?

• Do you have nausea or vomiting?

Other Related Symptoms

Similar symptoms or complaints

• Constipation

• Excessive gas

Symptoms from the same body system / part

• Throwing up blood

• Excessive burping

• Groin tenderness

• Bloated stomach

• White, pellet-like stools

Symptoms treated by the same specialty

• Heartburn

• Change in stool smell

• Fecal incontinence

• Stomach growling

• Diarrhea

Reviewed By:

Aiko Yoshioka, MD (Gastroenterology)

Dr. Yoshioka graduated from the Niigata University School of Medicine. He worked as a gastroenterologist at Saiseikai Niigata Hospital and Niigata University Medical & Dental Hospital before serving as the Deputy Chief of Gastroenterology at Tsubame Rosai Hospital and Nagaoka Red Cross Hospital. Dr. Yoshioka joined Saitama Saiseikai Kawaguchi General Hospital as Chief of Gastroenterology in April 2018.

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Feeling of incomplete emptying of the bowels after defecation

Feeling of incomplete emptying of the bowels after defecation – symptoms of which disease

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The most common symptom of a feeling of incomplete emptying of the bowels after a bowel movement is manifested in the following diseases:

• Hirschsprung disease
• Haemorrhoids
• Constipation
• bowel cancer
• Rectal cancer
• irritable bowel syndrome
• chronic colitis
• hemorrhoids in women
• postpartum hemorrhoids

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Rectocele – health articles

Rectocele – a diverticulum-like protrusion of the rectal wall towards the vagina, accompanied by a disorder in the act of defecation. Rectocele can be manifested by constipation, a feeling of incomplete bowel movement, the need for pressure on the perineum, buttocks, or vaginal wall to empty the bowels. Perhaps the development of hemorrhoids, anal fissures, cryptitis, pararectal fistulas and other complications.

The likelihood of a rectocele increases with age. Pathology is accompanied by a disorder in the evacuation function of the intestine, while the degree of disorder in the act of defecation directly depends on the severity of the rectocele. In severe cases, defecation without additional help (squeezing fecal masses through the vaginal wall) becomes impossible, other proctological and gynecological diseases develop.

Causes

Such a pathology as a rectocele can appear for the following reasons:

– constipation for a long time, which leads to dysfunction of the rectum;
– weakness, and congenital, of the muscular-ligamentous skeleton of the pelvic floor;
– pathological changes that have occurred in the levators, that is, in the muscles that lift the anus;
– seriously changed rectovaginal septum;
– anal sphincter dysfunction;
– various pathologies of the genital organs;
– dystrophy or atrophy of the rectovaginal septum, as well as the muscular group of the pelvic floor, which is associated with age-related changes in the woman’s body;
– chronic bronchitis, which is accompanied by bouts of severe coughing;
– too strong physical activity, for example, from heavy bags, a rectocele may well develop;
– obesity.

Symptoms

The following symptoms are characteristic of a rectocele: difficult stool; increased urge to defecate; feeling of incomplete emptying; when coughing, sneezing, urinary incontinence is observed; discomfort and pain during intercourse.

Women feel several symptoms of this unpleasant disease at once. The main one is a bulging of the rectal wall, felt as a foreign object in the vagina. It is accompanied by discomfort, as well as pain during intercourse. As a result, small vaginal bleeding may occur, which differs in nature from menstruation.

The disease is accompanied by stool retention, severe straining due to difficulty emptying. Pressing on the back wall of the rectum somewhat facilitates the process of defecation. However, after emptying, when the woman returns to an upright position, the urge to defecate is repeated. This is due to the movement of feces into the lower rectum.

Diagnosis

Diagnosis is based on the results of a digital examination of the rectum: when straining, a protrusion of the intestinal wall is detected.

Laboratory research methods are also prescribed: clinical and biochemical blood and erythrocyte tests, fecal occult blood analysis, coprogram – fecal analysis (you can detect undigested food fragments, a large amount of fat, coarse dietary fiber).

Instrumental research methods:

– Dynamic defecoproctography method – X-ray examination of the intestine during the process of defecation (rectal emptying) to identify possible damage to the muscular-ligamentous apparatus, difficulties in defecation.
– Sigmoidoscopy (visual examination of the rectum and part of the sigmoid colon using a special apparatus – an endoscope), the main method for diagnosing a rectocele.
– Irrigoscopy (X-ray examination of the colon with the introduction of a radiopaque (clearly visible in the picture) substance).
– Colonoscopy (visual examination of the large intestine using an endoscope). During these studies, a protrusion of the rectal wall is found.
– Computed tomography (CT) is performed to assess the condition of other organs of the abdominal cavity (liver, pancreas, bladder, kidneys, part of the unchanged intestine) and if complications of the rectocele are suspected, to identify them.
– Ultrasound examination (ultrasound) of the abdominal cavity and small pelvis to assess the condition of the gallbladder, biliary tract, pancreas, kidneys, intestines, to establish signs of stool retention in the intestines.

Treatment

Treatment should begin with the regulation of proper bowel function, which consists in following a certain diet. It is recommended to eat foods high in fiber and drink six to eight glasses of fluid daily. Fiber is able not only to increase the volume of feces, but also to make its consistency softer, as a result of which the feces move through the intestines without much difficulty and are more easily released. It is allowed to take funds to soften the feces.

If the symptoms of a conservatively treated rectocele persist, the doctor decides to perform surgery to remove the protruding part of the rectum and strengthen the rectovaginal septum. Rectocele surgery can be performed in a variety of ways. The indications for its implementation are a strong bulging of the rectocele, extending to the vestibule of the vagina or even beyond the genital tract.