Tenesmus: Definition, Causes, Treatment

Tenesmus: Definition, Causes, Treatment


Tenesmus is the persistent urge to use the bathroom, even if your bowel and bladder are empty. More commonly, tenesmus refers to the urge to make a bowel movement rather than to urinate.

Tenesmus can be a sign of an underlying condition affecting your digestive or urinary tract. Having the symptom can be challenging—frequent trips to the bathroom without relief and lingering discomfort caused by tenesmus can disrupt your daily life. Thankfully, there are ways you can manage tenesmus.

There are two types of tenesmus: rectal and vesical.

Rectal tenesmus affects your rectum. The rectum is located at the end of your large intestine and right before the anus, where stool (poop) exits the body. Rectal tenesmus causes you to feel like you need to poop even though you just had a bowel movement or there is nothing left to pass.

Vesical tenesmus affects your bladder, where your urine is stored. It causes you to feel like you need to urinate even after emptying your bladder. 

Usually, when the term tenesmus is used, it refers to rectal tenesmus.

The main characteristic of tenesmus is an urge to make a bowel movement even though your bowels are empty. Other symptoms of tenesmus can include:

  • Abdominal (belly) cramping or pain
  • Straining to pass stool or urine
  • Rectal or bladder pressure 

Sometimes, even if you strain very hard to make a bowel movement, only a small amount of stool will come out.

Tenesmus is a symptom of an underlying health condition affecting the gastrointestinal (GI) system and sometimes the urinary system. Your gastrointestinal (GI) system works to digest your food and excrete stool (waste in your body from food).

The GI system includes your stomach, small intestine (tubes that connect the stomach and large intestine), large intestine (tubes that carry food from the small intestine)—which includes the colon and rectum—and anus.

Your urinary system, including your bladder, removes waste and extra fluid from your blood by excreting urine.

Intestinal Inflammation or Infection

Inflammation—whether caused by infections or other conditions—can affect different parts of the gastrointestinal tract and cause rectal tenesmus. The inflammation can irritate the rectal lining and cause muscle spasms that lead to tenesmus.

One type of inflammation that can cause tenesmus is enteritis. Enteritis is small intestinal inflammation caused by infection (bacterial, viral, and parasitic), autoimmune conditions (conditions where the body mistakenly attacks itself), or dietary intolerance. Although rare, symptoms of enteritis may cause diarrhea, tenesmus, and abdominal cramps.

Infectious colitis is inflammation of the colon caused by bacterial, viral, or parasitic infections. In addition to tenesmus, symptoms may include bloody or mucusy diarrhea and abdominal pain. 

Proctitis is inflammation in your rectum caused by factors like inflammatory bowel disease (IBD) or radiation therapy. Proctocolitis is inflammation of the colon and rectum and can be transferred during sexual intercourse.

Symptoms of proctitis or proctocolitis may also cause:

  • Rectal pain
  • Rectal discharge or bleeding
  • Anal itching
  • Constipation or diarrhea
  • Abdominal pain

Constipation

Constipation is having infrequent or difficult bowel movements. Generally, constipation is defined as having three or fewer bowel movements a week. When constipated, stool in your body puts pressure on your rectal nerves and muscles, leading to spasms and a constant sensation of needing to pass stool.

Constipation may cause hard stools and painful bowel movements. It may also affect bladder function.

Motility Disorders

Motility disorders are a group of conditions that make it difficult for the body to control the intestinal muscles by causing nerve damage, muscle problems, or the communication of nerve responses.

Examples of motility disorders include irritable bowel syndrome (IBS) and chronic intestinal pseudo-obstruction (CIPO), a severe GI disorder that affects the stomach and intestines.

Motility disorders may cause belly pain, constipation, and bloating. 

Anorectal Disorders

Anorectal disorders are conditions that affect the anus and rectum. They include hemorrhoids, anal fissures, and rectal prolapse:

  • Hemorrhoids: Swollen veins in the rectum
  • Anal fissures: Small tears in the lining of the anus
  • Rectal prolapse: The rectum sticks out through the anus. The protruding tissue can cause bowel movements to feel incomplete.

Hemorrhoids and anal fissures can cause tenesmus due to the irritation and discomfort they create during bowel movements. Other symptoms of anorectal disorders can include rectal bleeding, rectal pressure or discomfort, and pain during bowel movements. 

Cancer

Cancer in your pelvic area (between your hips) can cause rectal tenesmus. The symptom is most common with cancer that affects your rectum. Rectal cancer might also cause rectal bleeding, belly pain, and fatigue. 

Cancer can cause tenesmus because tumors can cause nerve pain, muscle spasms, and difficulty passing stool. Even some cancer treatments, like radiation, can inflame the gastrointestinal lining and cause tenesmus.

Urinary Tract Infections (UTIs)

Urinary tract infections (UTIs) cause swelling in the bladder lining, leading to nerve sensitivity that can trigger vesical tenesmus. UTIs can also cause: 

  • Lower abdominal or pelvic discomfort 
  • Frequent urination in small amounts 
  • Burning or pain during urination
  • Foul-smelling urine 
  • Blood in the urine (visible in severe cases)
  • Incomplete bladder emptying

Interstitial Cystitis

Interstitial cystitis, also known as bladder pain syndrome, causes inflammation of your bladder lining. Inflammation in your bladder causes swelling that irritates nerves and muscles, resulting in vesical tenesmus.

Other symptoms may include frequent urination, nocturia (excessive urination at night), and pelvic pain.

If rectal tenesmus is suspected, you may be referred to a gastroenterologist (a doctor specializing in the GI tract). They will likely ask you about your symptoms and medical history. They may then do a physical exam. This could include pressing on your belly or performing a digital rectal exam.

A digital rectal exam involves a healthcare provider inserting a lubricated, gloved finger into the rectum to feel for any inconsistencies. You may feel a bit of discomfort during the exam.

They may also order the following diagnostic tests to determine the underlying cause of rectal and vesical tenesmus:

  • Urine tests: A urinalysis (examining urine sample) to check for underlying causes
  • Blood tests: Checks for signs of inflammation and infection
  • Sexually transmitted infections (STI) testing: Genital swabs or blood tests to verify whether or not you have an STI
  • Stool studies: Examines what is in your stool
  • Imaging tests: X-rays or scans that show the inside of your digestive tract and can spot tumors or signs of inflammation
  • Manometry: Placing a thin tube with sensors into the rectum to measure pressure and muscle movements in your anus and rectum
  • Endoscopy: A healthcare provider uses a flexible tube with a camera and light at its tip to examine the inside of your intestines for inflammation or signs of cancer. A colonoscopy examines your colon, a sigmoidoscopy visualizes the rectum and lower colon, and an anoscopy examines your anus and lower rectum. 

Treating your tenesmus depends on what condition your healthcare provider identifies as the cause. For instance, if constipation is causing your tenesmus, eating more fiber, using stool softeners, or taking laxatives (medications that stimulate a bowel movement) may help alleviate symptoms. Having an infection may require a prescription from a healthcare provider.

If you have IBD, you may need medications like aminosalicylates or corticosteroids to reduce inflammation, immunologic or biologic therapies to regulate the immune system, or surgery in severe cases. 

Colorectal cancer treatments like surgery, chemotherapy, or radiation may cause tenesmus. If you develop tenesmus after going through cancer treatments, antispasmodic medications or tricyclic antidepressants could offer relief. In addition, therapies like laser treatments, numbing injections, or pelvic floor therapy might help if recommended by your healthcare provider.

In addition to following your medical treatment plan, other strategies can help control your tenesmus.

Monitor and Avoid Triggers

Keep a journal of your daily foods and activities. This can help you identify what may be worsening symptoms like tenesmus.

For example, people with IBS may need to avoid spicy or greasy foods, dairy, and specific fiber-rich foods depending on how their body reacts to certain foods. Citrus, tomato products, and artificial sweeteners are common bothersome foods for people with gastrointestinal conditions. 

Make Dietary Changes

Drinking water and staying active can help you have consistent, smooth bowel movements and urinary function. You can also consider an anti-inflammatory diet, which may help relieve symptoms in certain underlying conditions.

An anti-inflammatory diet involves nutrient-rich, whole foods that provide essential vitamins, minerals, antioxidants, and omega-3 fatty acids. Examples include:

  • Lean protein 
  • Vegetables
  • Whole grains
  • Fruit
  • Nuts and seeds
  • Olive oil, avocados, and fatty fish
  • Spices like garlic, ginger, oregano, rosemary, and thyme

Anti-inflammatory diets restrict highly processed foods, refined sugar, and excessive alcohol.

Besides making dietary changes, practice stress management techniques like deep breathing, which can reduce muscle tension and stress that may worsen your tenesmus.

Take Probiotics

Probiotics are good bacteria that may prevent the growth of harmful bacteria in the intestines and urinary tract. Research suggests that taking probiotics may also help with gas relief and abdominal pain. Increasing probiotic intake might involve incorporating foods like yogurt, kefir, or kimchi, into your daily diet or taking supplements.

Try To Prevent UTIs

Steps to help prevent urinary tract infections (UTIs) include:

  • Drinking plenty of water to flush out bacteria 
  • Urinating frequently and completely 
  • Wiping from front to back
  • Urinating after sex
  • Avoiding harsh or scented hygiene products in the genital area
  • Getting more vitamin C
  • Consuming cranberry juice, pills, or extract

Tenesmus is an uncomfortable, persistent sensation of needing to have a bowel movement or urinate despite the bowels or bladder being empty. It is usually a symptom of an underlying health condition, such as a UTI, IBS, or hemorrhoids.

Tenesmus might cause you to have to use the bathroom more frequently. A healthcare provider can help you determine what is causing your tenesmus and choose the course of treatment that works best for you.

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