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Tenesmus is a medical condition that involves a persistent feeling of having to empty the bowels, even though there is no or very little stool left. It is a common symptom of several gastrointestinal disorders and can be both uncomfortable and frustrating. It often occurs with problems with the rectum or colon, where the feeling that the bowels are not completely emptied persists even after a visit to the toilet.
In this article, we will go over what tenesmus is, what common causes of the condition exist, and how it can be treated.
Tenesmus is defined as a constant or recurring feeling of having to empty the bowels, even though there is nothing left to empty. It can feel like a pressing or cramp-like pain in the abdomen or rectum, often in connection with defecation. In some cases, tenesmus can also be experienced as a feeling that the bowels are not completely empty after going to the toilet, which can create a need to go to the toilet several times in a short time without anything actually happening.
It is important to note that tenesmus is not a disease in itself, but rather a symptom of an underlying medical problem. Tenesmus usually occurs with inflammatory bowel conditions, infections, or mechanical problems in the rectum or colon.
Tenesmus can occur for a number of reasons, and it is often a sign that there is a problem in the gastrointestinal tract. Below are some of the most common reasons why tenesmus can occur:
Irritable bowel syndrome (IBS) is a common digestive disorder characterized by cramps, bloating, altered bowel habits, and sometimes tenesmus. IBS is caused by a hypersensitivity of the nervous system of the gut, which leads to changes in bowel movements. Many people with IBS experience feelings of incomplete emptying or a constant feeling of having to go to the bathroom. IBS is a functional disorder, which means it is not caused by visible damage to the intestines, but the symptoms can be very bothersome.
Inflammatory bowel disease, which includes ulcerative colitis and Crohn's disease, is characterized by chronic inflammation of the intestines. Ulcerative colitis usually affects the lower colon and rectum, while Crohn's disease can affect the entire gastrointestinal tract. Both conditions cause inflammation, swelling, and ulcers in the intestines, which can lead to symptoms such as diarrhea, abdominal pain, and tenesmus. Tenesmus is especially common in ulcerative colitis, as the inflammation in the rectum often leads to a feeling that the bowel is not emptying completely.
Bacterial and parasitic infections of the gut can cause tenesmus. Infections with bacteria such as Salmonella , Shigella or Campylobacter can irritate the lining of the gut and cause inflammation. These infections can cause symptoms such as diarrhoea, abdominal pain and tenesmus. Infections can be acute and transient, but in severe or long-term infections the symptoms can persist longer and cause a feeling of incomplete emptying.
Hemorrhoids (swollen blood vessels in the rectum) and anal fissures (cracks in the skin at the opening of the anus) can also cause tenesmus. These conditions can cause pain during bowel movements and a feeling that the bowel is not emptying completely. People with hemorrhoids or anal fissures may also experience a greatly increased feeling of having to go to the bathroom, even when the bowel has already emptied.
Colorectal cancer (cancer of the colon or rectum) is another possible cause of tenesmus. Tumors in the bowel can block the passage of the bowel, preventing stool from passing normally and causing a feeling that the bowel is not emptying completely. Tenesmus is a warning sign that something may be wrong with the bowel and should be investigated by a doctor, especially if it is accompanied by other symptoms such as blood in the stool, weight loss, or a change in bowel habits.
Mechanical problems such as strictures (narrowings) in the intestine or intestinal obstruction can also cause tenesmus. These narrowings can be due to scar tissue from previous inflammation or surgery, or due to tumors or other conditions that affect the function of the intestine. When the intestine becomes blocked or narrowed, it can prevent stool from passing properly, leading to a feeling of incomplete emptying and tenesmus.
Stress and anxiety can also play a role in the development of tenesmus. When the body responds to stress, the intestines can become more sensitive and reactive, which can lead to cramps, bloating, and a feeling that the intestines are not completely empty. Many people with IBS and other digestive problems report that their symptoms worsen during periods of stress or anxiety.
To determine the cause of tenesmus, it is important to undergo a thorough medical evaluation. Your doctor will usually start by asking you questions about your symptoms, including how long you have had tenesmus, whether you have any other symptoms (such as blood in your stool or weight loss), and whether you have any underlying medical conditions that may be contributing to the problem. Depending on the clinical picture, your doctor may recommend additional tests such as:
Blood tests to check for signs of infection or inflammation.
Colonoscopy to look at the inside of the intestine and look for signs of inflammatory diseases, tumors, or other abnormalities.
CT or MRI scans to examine the intestine for any strictures or blockages.
Stool samples to identify any infections or parasites.
Treatment for tenesmus depends on the underlying cause. If IBS is the cause, treatments such as dietary changes, probiotics, anti-seizure medications, and antidepressants (which sometimes help relieve symptoms) may be helpful. In inflammatory bowel disease, medications that suppress inflammation, such as corticosteroids or immunosuppressants, may be necessary.
Infections are often treated with antibiotics or antiparasitic agents, depending on the specific cause. For hemorrhoids or anal fissures, treatments such as local anesthesia, fiber therapy, and sometimes surgery may be necessary.
Tenesmus is a common but frustrating symptom that can occur due to a variety of causes, from functional disorders such as IBS to serious conditions such as colorectal cancer. It is important to seek medical attention if you experience tenesmus, especially if it is accompanied by other worrisome symptoms. With proper diagnosis and treatment, most causes of tenesmus can be effectively treated, providing relief and improving quality of life.
