Tenesmus (Bowel Urgency): Symptoms, Causes, Treatment

What are the symptoms of tenesmus?

Tenesmus is characterized by the feeling of needing to pass stool despite an empty bowel. The main symptoms of tenesmus include:

• Persistent Urge to Defecate: A constant sensation of needing to have a bowel movement, even if little or no stool is passed.
• Incomplete Evacuation: Feeling that the bowel has not been completely emptied after a bowel movement.
• Abdominal Pain or Cramping: Discomfort, cramping, or pressure in the rectum or lower abdomen.
• Straining During Bowel Movements: Excessive effort needed to try to pass stool.
• Small Amounts of Stool or Mucus: Passing only small amounts of stool, mucus, or nothing at all when attempting to have a bowel movement.
• Rectal Pain: Pain in the rectal area, often worsening with the sensation of needing to pass stool.

These symptoms can be distressing and may be associated with underlying conditions like inflammatory bowel disease (IBD), infections, colorectal cancer, or other gastrointestinal issues.

What are the causes of tenesmus?

Tenesmus is typically caused by conditions that irritate or inflame the rectum or lower bowel. Common causes include:

1. Inflammatory Bowel Disease (IBD): Conditions like Crohn’s disease and ulcerative colitis cause chronic inflammation of the digestive tract, leading to symptoms like tenesmus.
2. Infections: Bacterial, viral, or parasitic infections (such as those caused by Shigella, Salmonella, or Campylobacter) can lead to rectal inflammation and tenesmus. Some sexually transmitted infections, like herpes or gonorrhea, can also cause this symptom.
3. Irritable Bowel Syndrome (IBS): Although IBS is not inflammatory, it can still cause the sensation of incomplete bowel movements and tenesmus.
4. Colorectal Cancer: Tumors in the rectum or colon can block the passage of stool, leading to tenesmus.
5. Proctitis: Inflammation of the rectum, often caused by infections, radiation therapy, or autoimmune conditions, can result in tenesmus.
6. Diverticulitis: Inflammation or infection of diverticula (small pouches that form in the colon) can lead to discomfort and tenesmus.
7. Rectal or Anal Trauma: Injury or surgery affecting the rectum or anus can cause irritation and tenesmus.
8. Hemorrhoids or Rectal Fissures: Enlarged hemorrhoids or tears in the anal lining can create a sensation of incomplete evacuation.
9. Pelvic Floor Dysfunction: Problems with the muscles that support the rectum can cause difficulties with bowel movements and lead to tenesmus.
10. Radiation Therapy: Radiation directed at the pelvis or lower abdomen (for cancers like prostate or cervical cancer) can cause inflammation and irritation in the rectum, leading to tenesmus.

Identifying the underlying cause of tenesmus is crucial for proper treatment and relief of symptoms.

What is the treatment for tenesmus?

The treatment for tenesmus depends on addressing the underlying cause of the condition. Here are common treatment approaches based on the cause:

1. Anti-inflammatory Medications: For tenesmus caused by inflammatory bowel disease (IBD) such as Crohn’s disease or ulcerative colitis, medications like corticosteroids, aminosalicylates (e.g., mesalamine), or biologics may be prescribed to reduce inflammation.
2. Antibiotics or Antivirals: If tenesmus is due to bacterial, viral, or parasitic infections, appropriate antibiotics, antivirals, or antiparasitic medications will be used to treat the infection.
3. Dietary Modifications: For conditions like irritable bowel syndrome (IBS), dietary changes, such as increasing fiber intake or avoiding trigger foods, can help manage symptoms and reduce tenesmus.
4. Treatment for Colorectal Cancer: If tenesmus is caused by a tumor, treatment may involve surgery, chemotherapy, radiation, or a combination of these therapies, depending on the stage and location of the cancer.
5. Treatment for Proctitis: Proctitis (inflammation of the rectum) can be treated with anti-inflammatory medications, antibiotics (if infection is the cause), or topical treatments like suppositories or enemas.
6. Managing Hemorrhoids or Rectal Fissures: Treatments include topical creams, warm sitz baths, stool softeners, and in some cases, surgical procedures to remove or reduce hemorrhoids or repair fissures.
7. Pelvic Floor Physical Therapy: For tenesmus related to pelvic floor dysfunction, specialized exercises and physical therapy can help improve muscle function and alleviate symptoms.
8. Pain Relief: Over-the-counter or prescription pain relievers can help manage discomfort. In some cases, antispasmodic medications may be prescribed to reduce cramping and the sensation of needing to pass stool.
9. Surgery: In cases where tenesmus is due to structural issues like strictures, blockages, or tumors, surgery may be required to correct the problem.
10. Supportive Care: Ensuring adequate hydration, managing stress, and practicing good bowel habits can help manage tenesmus symptoms, especially in chronic conditions like IBS or IBD.

Early diagnosis and treatment of the underlying cause are key to effectively managing tenesmus and preventing complications.