Tenesmus is a feeling of incomplete or unfinished defecation. It is both a mental and physical condition. If you ever have a feeling of running to the bathroom often continue reading.
The feeling of the need to pass stools even when the bowels are empty is known as Tenesmus. This could be because of an underlying cause of a simple infection or as serious as cancer.
According to the cause tenesmus could last for a few days and in serious cases could have long periods of frequent occurrences. Because of the inflammatory condition of the bowels, it may be hard to empty the bowels even for the smaller amount of stools.
Because of the underlying cause, there is the urgent frequency of rushing to the bathroom to evacuate the bowels when even nothing comes out. Even with the tiniest of bowel movements, there is a need to run to the bathroom. Apart from causing straining, the pain it could also affect normal life with the mental stress.
In the period of tenesmus the urgency, cramping, straining and rushing to the bathroom is ever present. The fact that, when it is going to be triggered and return back is not known which makes the effect worse.
Constipation could be also one of the reasons for tenesmus and the small amount of stool left in the rectum make the tendency to going to the bathroom often. Some faulty nerve signals could also create the feeling of unfinished tenesmus.
Tenesmus is also known as Rectal Tenesmus and is in contrast to that of Vesical Tenesmus which is related to the urinary bladder. It is a feeling or condition of being unable to completely empty the urinary bladder even when there is urine present in it.
Symptoms of tenesmus depend on the underlying cause and could be sudden out of nowhere.
Having multiple tiny bowel movements throughout the day.
Cramping in the intestines and stomach
Urgent urge even with a small bowel movement to rush to the bathroom without any stool to defecate
Pain and strain when trying to defecate
Due to constipation cannot empty the bowels
Anxiety and distress with the normal activity of defecation
Gas and bloating in the stomach
Rectal itching in the mouth of the anus
Fever with a temperature of more than 100 degrees Fahrenheit
Chills accompanied with severe pain
Blood in the stools
Mucous discharge from the anus
Nausea, vomiting, and fainting
The cause of tenesmus could vary as per the underlying disease.
Crohn’s Disease:
Inflammatory bowel disease is called Crohn’s disease. The exact cause is still to be ascertained by the medical world. Some common causes are genetics, the immune system, and the environment.
Crohn’s disease affects any part of GI or the gastrointestinal tract. It may affect from the mouth to anus causing several issues. It is more prominent with IBD or inflammatory bowel disease.
18 % of people with Crohn’s disease showed symptoms of tenesmus by a recent study. It apart from tenesmus could cause serious medical issues and if not treated in time or properly needs surgery of the removing the affected part or could be fatal.
Chlamydia is common STI or sexually transmitted infection more common with heterosexual females. The symptoms are less in the initial stages and when not treated properly could lead to issues during pregnancy and in some case endangering pregnancies.
Ulcerative colitis is one of the IBD or inflammatory bowel diseases affecting the GI tract. The inflammation in the bowel causes to move its contents rapidly and empty it frequently.
Ulcerative colitis occurs when the colon or rectum is inflamed. Colon is the lining of the large intestine. In some cases, both the colon and rectum are inflamed and cause serious medical conditions.
Tenesmus symptoms are found in 90 % of the ulcerative colitis patient. The reason again is still not clearly known but if not treated could lead to surgery. For many, the treatment continues for a lifetime.
Polyps are abnormal tissue and cell growth which leads to cancer. Polyps occur in many parts of the body and most commonly in the colon. This is called colorectal tumors.
Colorectal tumors are the second main cause of death among women affected by cancers and the third in men.
When ulcerative colitis is untreated or becomes severe these colorectal tumors occur and needs immediate surgery to save a life.
Anorectal abscess:
The anus or rectal abscess occurs when the cavity in the anus becomes filled with pus. This is more painful and requires immediate medical attention.
This is most common with STI and HIV affected people and for those who have anal sex. This could cause a lot of discomforts. Having safe sex with good and hygiene environment could prevent anorectal abscess.
This is one rare form of cancer and causes undesirable issues. It is considered mainly due to the HPV or human papillomavirus which is spread by STI.
A weak immune system and smoking also cause anal cancer. HPV infection can be reduced by proper and safe sex and also by quitting smoking.
Thrombosed hemorrhoids are enlarged vascular tissue in the lower rectum and anus. This is the opening at the end of the large intestine for the stool to leave the body. When the hemorrhoids are swollen and cause itching around the anus and thus makes the bowel movements uncomfortable.
It could also be a lot painful and even going to the bathroom could be a difficult task. If pain, swelling is accompanied with fever it could lead to the formation of an abscess which is the cavity of anus filled with pus.
Three out of four people are prone to be affected by hemorrhoids at least once in their life. It can be cured with proper medication and less than 10 percent affected by hemorrhoids needs surgery to cure them.
Endometriosis is a condition with the tissue that makes up the womb or uterine lining is present on other organs inside the body. It can appear anywhere in the body and usually found in the lower abdomen or pelvis causing discomfort with bowel movements.
Women with endometriosis often have pain mainly at the lower abdomen. This could cause pain during intercourse and also makes pregnancy difficult or totally impossible.
Approximately 20 to 40 % of infertile women have endometriosis. This is because endometriosis causes infertility in two ways.
Distorting the fallopian tubes making them unfit to pick up the egg after ovulation.
The second is by creating inflammation that can adversely affect the function of the ovary, egg, uterus or fallopian tubes.
One of the risks of radiation for treatment of the human body is radiation enteritis. This causes inflammation of small and/or large intestine along with the rectum and sexual organs.
This also a side effect of x-rays or radiation but this time on the lower parts of the colon. After a few weeks of the therapy if there is an urgency to the frequent bathroom with diarrhea it confirms radiation proctitis.
Celiac disease is a serious autoimmune disorder that involves the intestine and digestive systems. One in every hundred of the human population is affected by this disease.
This disorder occurs among genetically predisposed people with the gluten ingestion affecting the small intestine. This causes abdominal pain and bloating among other symptoms.
When this gluten intolerance is untreated for a long time could lead to serious complications. This could be from the non-absorption of nutrients to infertility.
Constipation apart from physical discomfort could cause various ailments. They are characterized by infrequent, difficult, perceived, incomplete evacuation of bowel movements.
Millions around the world are suffering from constipation day today and it ranges from 2 – 28 % of the population as per the demographic locations. And it is more common with women than men and increases with age.
Chronic constipation is a serious condition of secondary level of constipation due to underlying ailments like IBD, IBS and many more.
Diarrhea is defined as loose or watery stools which are experienced by many people at some point in their life. But when it persisted for a few weeks with usually more than three loose stools per day it is a serious condition and called chronic diarrhea.
Diverticula are small pouches that develop along the walls of the intestines. The infection of the inflammation of these pouches is called diverticulosis. The serious condition of diverticulosis is diverticulitis.
The pouches may develop in any part of the digestive tract and the most common part is the left side of the abdomen where the descending sigmoid colon ends.
Diverticulitis may form a small abscess in one or more of the pouches resulting in massive infection or perforation of the bowel.
Fecal impaction or impacted bowel causes the feces to become dry won’t easily budge to excrete from the body. This also blocks the new waste to defecate.
During the digestion process, the walls of the intestine absorb the nutrients from the food. The waste remains passes to the colon and rectum. When the digestion process goes wrong for some reason the feces becomes dry which is the condition called fecal impaction of the colon.
This apart from tenesmus causes leakage of liquid stool which is a disturbing factor for normal living. Jet lag, spinal cord injury and many other reasons cause fecal impaction.
IBD or inflammatory bowel disease is one of the main causes of Tenesmus. IBD is a group of disorders in the intestines to become inflamed. It was thought to be an autoimmune disease for a long time.
But researchers found that it is because of the immune system attaching a harmless virus or bacteria or food in the gut, causing inflammation which leads to bowel injury.
IBD could be because of genetic reasons and runs into the family. Millions are affected by IBD which apart from many other diseases mainly due to the ulcerative colitis and Crohn’s disease.
Ulcerative colitis is restricted to only the colon but the Crohn’s disease can affect any part of the GI tract from mouth to the anus. But conditions like Tenesmus are due to the affection of the small intestine or colon or in some cases both.
IBD diseases when untreated can cause permanent damage to the intestines resulting in bleeding and other serious conditions. This is the major reason for developing the higher risk of colon or rectal cancers.
IBS or irritable bowel syndrome affects more than 50 million Americans and is more common with the people of age group from teens to the age of 40. It is the combination of the two extremes of defecation namely constipation or diarrhea.
IBS is a condition of pain and trouble coupled with belly discomfort. Even though it is not a life-threatening disease it could cause a lot of damage to the quality of life.
Many people suffering from IBS have to change their professional lifestyle and could even end up without a profession to stay at home.
IBS differs from IBD from the fact that it has fewer complications of the disorder itself. This has lesser serious complications such as cancer and a variety of disease like IBD.
Even though it is an embarrassing experience with a doctor it should be done without delay. Tenesmus is caused by various underlying ailments. Hence a variety of tests with the careful physical and medical examination by the doctor should be done.
The following is the questions the doctor will ask to evaluate the disease.
Bowel habits
- A family history of tenesmus
- Duration of the symptoms and its frequency, onset, and severity
- Other health issues
- Lifestyle and diet habits
After these questions the doctor will have a detailed abdominal and digital rectal examination before prescribing any of the following tests:
- Blood tests
- Stool culture for disease-causing bacteria
- Xray of the abdomen
- CT scan of the abdominopelvic area
- Screening of the STI or sexually transmitted infections like a chlamydial infection of the rectum
- Colonoscopy is done to examine the entire colon
- Sigmoidoscopy is done to examine the last sections of the colon
- Hemoccult test to check for traces of blood in the stool
- FBC or full blood count also called as CBC or complete blood count to detect the infection of anemia
- ESR, Erythrocyte sedimentation rate or CRP, C-reactive protein to check for generalized inflammation
- MRI or magnetic resonance imaging to check for tumors and other soft tissue abnormalities
- Barium X-ray to check for bowel obstruction or perforation
Tenesmus is typically treated for the underlying condition. If the symptoms persist and become severe it is time to take proper medical treatment after correct diagnoses.
Tenesmus is largely unresponsive to opioid drugs like illegal heroin. Even synthetic opioids like fentanyl and pain relievers like morphine, Oxycontin, Vicodin, among others are of no use for tenesmus. The traditionally used benzodiazepines and phenothiazines are also proved ineffective.
Some common medical treatments available to ease the symptoms of tenesmus include:
- Laxatives to help ease constipation
- Antidiarrheals like Loperamide or bismuth sulfate
- Anti-inflammatory drugs which can be taken orally or rectally
- Anti-spasmodic drugs like dicyclomine or hyoscyamine (Levsin) to help ease involuntary muscle contractions
- TCAs or tricyclic anti-depressants to manage symptoms of IBS related tenesmus
- Immune-modulating drugs like Azathioprine (Imuran) and Purinethol (6-mercaptopurine) to help suppress the inflammation caused by Crohn’s disease and ulcerative colitis.
- In the case of alleviated intractable rectal pain caused by advanced colorectal cancer, methadone is prescribed.
- Immune system suppressors are used to inhibiting the immune system response that causes inflammation.
- Corticosteroid therapy which involves using the fast-acting systemic steroids is also applied. These manage the flare-ups of IBD by causing immune-suppression and reducing inflammation.
- Another subclass of immune-suppressants like monoclonal antibody is used in the biologic therapy. These immune-suppressants target substances in the body which cause inflammation.
- Antibiotics and anti-parasitics are used against bacteria that may cause symptoms or make them worse with tenesmus. These are the normal treatment for motility disorders.
- SSRIs or selective serotonin reuptake inhibitors are also prescribed. They modulate the chloride channels and serotonin. Care should be taken while using SSRIs. This is because of the side effects which include dry mouth and eyes along with weight gain, sedation, visual changes, and urinary retention.
- Anticholinergics are usually taken before meals during the start of the symptoms.
- Anticonvulsants are used to treat chronic pain.
- Probiotics or good bacteria is used to colonize the gut if an infection is present.
- Endoscopy therapy is rarely done to treat tenesmus.
- Surgical procedures are done to widen the narrow bowel an to remove the blockages that are causing IBD and tenesmus symptoms.
- Due to fecal impaction, the impacted stool which is stuck in the colon may be manually removed by the doctor. It can also be flushed out with a rectal laxative enema or water irrigation.
Some home remedies and lifestyle changes can help many people with controlling and managing the tenesmus symptoms. Management will also depend on the cause. Constipation and diarrhea are the two major factors which should be managed properly for reducing tenesmus.
The following management options and techniques could also be used as preventive measures for tenesmus.
Stress is the reason for many ailments of the human body. Anxiety and stress are part and parcel of modern day life. Managing stress with a proper lifestyle is the basis of being healthy.
Meditation, yoga, pranayama or deep breathing exercises and progressive muscle relaxation are some effective stress management tools.
IBD and its symptoms flare up during periods of high stress. Also, stress creates ulcers in the abdomen and also constipation and many others.
Keeping the body hydrated at all times is one effective way of managing the symptoms of tenesmus. Drinking enough water and other fluids will prevent dehydration, which is the main reason for constipation.
Being hydrated helps to make the stool soft and its passage outside easier. This could be the basic management step for reducing tenesmus symptoms.
Lack of physical activity reduces the bowel movements and the activity of the intestines. This could cause for many symptoms of tenesmus. Regular physical activity will solve this issue and get rid of the symptoms of tenesmus.
Diet and proper food intake is the right step for controlling and preventing all the abdomen and digestive ailments. The best diet plan for reducing symptoms of tenesmus could be of high fiber diet.
It is important to discuss individual needs with a doctor before making any dietary changes. The European Food Safety Authority recommends an intake of a minimum of 25 grams of dietary fiber daily.
Fiber reduces the chances of constipation. Some fiber-rich foods are listed below:
- Fruits and vegetables
- Whole grains
- Nuts and seeds
- Beans and lentils
But care should be taken in some rare cases of IBD the intake of high levels of fiber will narrow the inside of the bowel.
As per the Journal of Clinical Advances in Gastroenterology patients suffering from IBD or IBS the major concerns of tenesmus should have equal amounts of 33 % of clean protein sources, healthy fats, and low glycemic carbohydrates.
Eating probiotic and prebiotic foods
Eating smaller meals will reduce the pressure on the GI tract.
Avoiding alcohol, smoking, caffeine, and food that causes symptoms of tenesmus is also equally important.
Hence proper lifestyle with healthy food habits keeps us away from many ailments including tenesmus symptoms. The stress of daily life should be reduced or controlled totally with proper tools like meditation, yoga, and regular exercises.
Stress-free and happy life saves not only the money and time for treatments but also gives a happy life.