Tenesmus There is often a feeling of urgency to defecate, even though the bowels are empty. It is accompanied by discomfort, cramping, tension, and rectal pain.
Tenesmus can be caused by a variety of gastrointestinal disorders, such as hemorrhoids, infections, and inflammatory bowel disease (IBD). This can also be a symptom of colon cancer, so it’s important to talk to your health care provider if you experience this symptom.
This article describes possible causes of tenesmus. It also describes what health care providers do to diagnose and treat this common but often painful condition.
Causes of tenesmus
The term “tenesmus” refers to the feeling of having to defecate (to defecate) when there is no need to do so. Doctors don’t fully understand why tenesmus occurs, but other symptoms can cause changes in the body that can lead to this uncomfortable and painful problem.
conditions
Tenesmus is essentially a sign that your digestive system is not functioning properly. Nerve problems, inflammation, intestinal scarring, and other problems that affect digestion and excretion are caused by a variety of conditions.
Below are some diseases that can cause tenesmus.
Radiation therapy for cervical, rectal, prostate, or colon cancer can also cause damage or inflammation to the rectum. This can cause tenesmus, as well as symptoms such as diarrhea and pain.
nerve problems
It is thought that inflammation in the intestines can affect the nerves that control waste excretion. When these nerves become overstimulated, they can send signals to the brain that there is still material in the intestines.
This can irritate the intestinal muscles used to push stool out. Because these muscles contract, the body thinks it needs to have a bowel movement, but there is actually nothing in the colon.
intestinal damage
Another possible cause of tenesmus is intestinal scarring caused by severe diarrhea or constipation. When this scar tissue builds up, it becomes difficult to defecate.
It may also feel like there is more in your intestines than there actually is. The same thing can happen with wounds or tumors around the rectum or in the colon.
When to call your health care provider
Seek immediate medical attention if you experience high fever (100.4 degrees Fahrenheit or higher), chills, severe rectal bleeding, nausea, vomiting, or tenesmus with fainting.
Associated symptoms
You may also notice other symptoms associated with tenesmus, including:
- convulsions
- strain to push out stool
- rectal pain
Symptoms of tenesmus may be always present or may come and go.
Other problems that can occur with tenesmus, such as abdominal pain or rectal bleeding, are usually related to an underlying condition that makes you need to go to the bathroom.
diagnosis
Your health care provider may recommend seeing a specialist who can diagnose the cause of 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.
Your health care provider then performs further tests to find the underlying reason for your symptoms.
Physical examination
A physical examination is essential for diagnosing tenesmus. This helps your doctor check for inflammation or abnormalities around your rectum, abdominal tenderness or pain, or signs of sexually transmitted infections (STIs).
Testing may include a digital rectal examination (DRE). This involves inserting a gloved finger into the anus to check for hemorrhoids, blood, mucus secretion, infection, or abnormal growths.
clinical examination
After a physical exam, your doctor will usually order a number of blood and stool tests to narrow down the cause.
These may include:
image research
Before proceeding with more invasive procedures, your doctor may order imaging tests to visualize your gastrointestinal tract.
These may include:
- barium x-ray: A type of X-ray that uses a barium enema to highlight growths, obstructions, lesions, or perforations (holes) in the intestines
- Computed tomography (CT) colonography: An imaging technique that uses multiple X-rays to visualize the intestines in detail, including the presence of polyps and tumors.
- Magnetic Resonance Imaging (MRI): a type of scan that uses powerful magnetism and radio waves to create highly detailed images of the soft tissues in the gastrointestinal tract
procedure
If your doctor suspects colorectal cancer or finds abnormalities on imaging tests, your doctor may refer you to another health care provider. gastroenterologista doctor specializing in gastrointestinal diseases.
Additional tests may be needed to confirm the diagnosis.
- colonoscopy: A procedure in which the entire colon is examined using a flexible scope called a colonoscope.
- 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 tissue samples 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 tests can support the diagnosis, but they cannot diagnose the disease.
tenesmus treatment
Tenesmus tends to improve once the underlying cause is identified and treated. Because the causes of tenesmus are very diverse, so are the treatments. Below are treatments used for conditions that cause tenesmus.
| cause | treatment options |
|---|---|
| celiac disease | gluten free meals |
| constipation | Laxatives and stool softeners |
| high fiber diet | |
| diarrhea | Anti-diarrheal drugs such as Imodium (loperamide) |
| colorectal cancer | surgery |
| radiation | |
| Chemotherapy, immunotherapy, and/or targeted therapy | |
| Crohn’s disease and ulcerative colitis | Corticosteroids such as prednisone |
| Immunosuppressants such as methotrexate | |
| Aminosalicylates such as Colazar (balsalazide) | |
| TNF inhibitors such as Humira (adalimumab) | |
| Antibiotics such as Flagyl (metronidazole) | |
| surgery | |
| diverticular disease | high fiber diet |
| Oral or intravenous antibiotics | |
| surgery | |
| gastroenteritis | Antibiotics (if bacterial cause) |
| Antiparasitic drugs (if the cause is a parasite) | |
| IBS | high fiber diet |
| Antispasmodics such as Levsin (hyoscyamine) | |
| Anti-diarrheal or laxatives as needed | |
| Tricyclic antidepressants such as amitriptyline | |
| ischemic colitis | Antibiotics |
| Surgery if blood flow disorder is severe | |
| pelvic floor disease | stool softener |
| physical therapy | |
| Transcutaneous 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 | |
| sexually transmitted diseases | Antibiotics (depending on infection) |
summary
Tenesmus is the feeling of needing to defecate even when the colon is empty. Depending on the underlying cause, it may be accompanied by other symptoms such as cramping, pain, and rectal bleeding.
Causes range from relatively harmless causes such as diarrhea and constipation to serious causes such as cancer. To determine the cause, your health care provider will do a physical exam, such as a digital rectal exam. Tests such as blood tests, imaging tests, and colonoscopies and biopsies may also be needed.
Once the cause is identified, the underlying condition must be treated to eliminate tenesmus. Many of these conditions require dietary changes, medication, or surgery to alleviate symptoms.
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