Incomplete defecation, or the feeling that you still have to defecate even though it hasn’t passed, can be uncomfortable and frustrating.
This is also known as incomplete emptying and is a hallmark of irritable bowel syndrome (IBS). It can also be caused by chronic constipation, pelvic floor disease, or infection. Fortunately, there are ways to deal with this worsening and surprisingly common condition.
Very Well / Cindy Chan
This article explains why incomplete evacuation occurs and outlines various pharmacotherapy, self-care, and psychotherapeutic treatment options.
What is incomplete evacuation?
Remaining stool is the feeling that you have had a bowel movement, but it is not yet finished. This is not an uncommon symptom for people with chronic (frequent or persistent) constipation or chronic diarrhea.
Chronic constipation can cause the rectum, anus, and colon to become very sensitive due to the passage of small, hard stools. The same thing can happen with chronic diarrhea, especially when you strain. You may also experience an uncontrollable clenching sensation even when you don’t have a bowel movement.
Two mechanisms are thought to underpin incomplete emptying in patients with IBS with constipation (IBS-C) and IBS with diarrhea (IBS-D).
- Visceral hypersensitivity refers to hypersensitivity to pain within internal organs (in this case, the colon, rectum, and anus).
- Dysmotility occurs when the muscles of the gastrointestinal tract are not working properly, interfering with the ability to pass comfortable, well-formed stools.
Straining during defecation can also cause hemorrhoids and can also cause tenderness or a feeling of “something” in the rectum.
What causes incomplete evacuation?
Incomplete bowel movements are often associated with constipation, but they can also be caused by other common or less common illnesses.
Possible causes of incomplete evacuation include:
How to completely empty the intestines regardless of the cause
Whether you have diarrhea or constipation, there are some universal methods that can help you completely empty your bowels.
- Stay hydrated: Aim to drink at least 64 ounces of water a day to keep your digestive tract well hydrated and moving.
- keep active: Physical activity promotes the transport of waste products in the intestines.
- eat more produce: Fruits and vegetables are rich in dietary fiber, which helps regulate bowel movements.
- raise one’s feet: Posture-altering devices, such as footstools, create an easier path for poop to drain.
- try an enema: An enema injects fluid into the colon to loosen fecal impaction and remove remaining waste.
If these are not sufficient, additional treatments may be recommended depending on your symptoms.
Incomplete elimination due to constipation
If you have constipation, the feeling of incomplete emptying may be accurate. Difficulty defecating can result in the inability to completely empty the rectum, which can leave you feeling dissatisfied and uncomfortable.
To counter this effect, your health care provider may prescribe medications to help your intestines clear stool. You may also benefit from simple self-care strategies you can try at home and other forms of therapy that target the gut-brain connection to reduce symptoms.
Prescription drugs
The Food and Drug Administration (FDA) has approved two drugs to treat IBS-C: Linzess (linaclotide) and Torlans (plecanatide). Both drugs are classified as: Guanylyl cyclase activator, targets receptors in the intestine. This stimulates an increase in intestinal fluid, which can lead to:
- keep stool soft
- Helps reduce abdominal pain
- Helps reduce bowel movements
- Reduces IBS symptoms
These drugs are considered safe and well-tolerated, with the most common side effect being mild to moderate diarrhea.
Although tricyclic antidepressants are not specifically approved to treat IBS, they are known to have therapeutic effects on the gastrointestinal system. Because of this, his health care provider may prescribe them off-label to treat his IBS symptoms, such as abdominal pain.
Tricyclic antidepressants help maintain serotonin levels in the intestines, reduce inflammation, and promote intestinal motility. Motility refers to the movement of food and stool through the intestines.
Commonly prescribed tricyclic drugs include:
- Elavil (amitriptyline)
- Tofranil (imipramine)
- norpramine (desipramine)
- Aventil (nortriptyline)
Both of these approaches are recommended in the American College of Gastroenterology (ACG) clinical guidelines for IBS management published in January 2021. Lindseth and Turans are especially recommended for his IBS-C, and tricyclics are recommended for all his IBS subtypes.
self-care strategies
If you have IBS-C, you can also try some self-care strategies at home to ease the feeling that evacuation is incomplete.
- Gut retraining: Most people have a bowel movement in the morning, but not so much at night. Pay attention to your own biological rhythms and schedule yourself to go to the bathroom at the same time every day.
- Visualization: As you assess the “completeness” of the movement, imagine an empty rectum, giving your body time to expel as much stool as possible.
- Soluble dietary fiber intake: Gradually increase your intake Consume foods rich in soluble fiber (but not insoluble fiber) or try a psyllium-based fiber supplement. Foods rich in soluble fiber include bananas, blueberries, kiwi, oranges, carrots, eggplant, green beans, oatmeal, zucchini, and potatoes with skin.
The ACG guidelines specifically state that while insoluble fiber has not been shown to improve IBS symptoms in studies, soluble fiber does. Insoluble dietary fiber is found in foods such as wheat bran and vegetables.
Adequate fiber intake is defined as 25 grams for adult women and 38 grams for adult men. If you have trouble getting enough soluble fiber in your diet, consider including a fiber supplement to increase your intake.
Gut-driven psychotherapy
Defecation insufficiency There is a problem with the function of the nerves and muscles used to pass stool. If you think you have this problem, you may want to consider biofeedback or physical therapy as a way to alleviate your symptoms.
Gut-directed psychotherapy is increasingly attracting attention as an effective complementary therapy for IBS and is recommended by the ACG guidelines.
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 reduce sensitivity to pain and encourage the mind to better regulate bowel movements.
Incomplete evacuation with diarrhea
For people experiencing chronic diarrhea, the sensation of incomplete evacuation is much more complex.
This is known by the umbrella term “tenesmus,” but there is a lack of research into the causes of this phenomenon, which occurs without an obvious physiological reason.
Fortunately, effective treatments are available to alleviate symptoms.
Prescription drugs
Sifaxan (rifaximin) is an FDA-approved antibiotic for the treatment of IBS with diarrhea (IBS-D), and this treatment is also supported by ACG guidelines.
Xifaxan remains active in the gastrointestinal tract but is not absorbed. This is a factor that contributes to its safety profile, as it is less likely to interact with other drugs or become less effective over time. Side effects from rifaximin are mild and rare, but may include:
- diarrhea
- loss of taste
- anorexia
- nausea
- inflammation of the nose
self-care strategies
If your stool is loose and watery, the hard stool that was in your colon may have already been passed out. However, due to nerve and muscle dysfunction, you may still feel like you need to empty your bowels.
A good way to counteract this sense of urgency is to tell yourself that you don’t need to pass any more stools.
Keep in mind that there is no such thing as a truly empty bowel, as new stool is constantly being produced. When it comes to worrying about future diarrhea symptoms, remember that hard stools are easier on your anal muscles than watery stools that aren’t ready to be passed.
If you constantly feel the urge to go to the bathroom, try delaying your time. Sit quietly in a spot near the toilet and see if you can do some relaxation exercises to calm your body until you no longer feel the urge to go to the toilet again.
Calming your body also helps reduce anxiety that may be causing your nervous system to keep sending signals for more (unnecessary) elimination.
Similar to IBS-C, gut-directed psychotherapies such as CBT are recommended as complementary treatments to improve IBS symptoms and associated distress.
summary
Incomplete emptying, or the feeling that a bowel movement is not completed, is common in people with chronic constipation or chronic diarrhea, especially in people with irritable bowel syndrome (IBS).
Treatment options for patients with constipation-prone IBS (IBS-C) include a high-fiber diet, bowel retraining, gut-directed psychotherapy, and medications like Turance and Lindseth.
For patients with diarrhea-predominant IBS (IBS-D), options include bowel retraining, gut-directed psychotherapy, and the antibiotic xifaxane.