Rectal Tenesmus: What It Is, The Causes, Symptoms, and Treatments

A constant feeling of wanting to have a bowel movement and not being able to do so may be indicative of rectal tenesmus. Read on and we'll tell you more.

Rectal tenesmus is that almost constant sensation of wanting to defecate, but not being able to do so. In addition, there may be pain in the abdomen, cramping, painful and very scanty bowel movements.

Although they may be associated, they shouldn’t be confused with constipation. In the case of rectal tenesmus, the urge to defecate persists, even when the bowels are empty.

There are several causes of this problem. They are usually associated with inflammatory bowel diseases or motility disorders. The treatment will depend on the cause.

What is rectal tenesmus?

Rectal tenesmus is the name given to this condition, in which the person experiences an intense, constant, and urgent need to evacuate, but without succeeding.

Sometimes it also happens that, even when the person has managed to defecate, he/she still has the urge. That is, all those sensations that accompany or announce the desire to go to the bathroom don’t disappear.

Therefore, rectal tenesmus can occur even when there is no stool in the intestines. Often, the person feels that he or she does not empty the bowels completely.

In addition to the above, other symptoms are experienced, such as the following:

• Constipation
• Straining to defecate
• Abdominal pain and cramping
• Painful and difficult bowel movements
• Scanty or absent stool
• Presence of mucus in the stool

The causes of rectal tenesmus

There are several causes that can lead to the occurrence of rectal tenesmus. It’s often related to other health problems, such as those discussed below.

Proctitis

Proctitis is inflammation of the lining of the rectum or colon. It can occur for various reasons, such as radiation therapy, infectious diseases (gastroenteritis), and even be sexually transmitted.

Symptoms include diarrhea, anal pain, and bleeding with stool. Rectal tenesmus is also often a sign of proctitis.

Intestinal infection

Infectious colitis and other intestinal infections can be caused by different types of microorganisms (bacteria, parasites, viruses). The accompanying symptoms vary, but include rectal tenesmus, abdominal pain and cramping, and diarrhea.

Inflammatory bowel disease

The term inflammatory bowel diseases encompasses a group of conditions, such as ulcerative colitis and Crohn’s disease. They can have a variety of symptoms, such as abdominal swelling, severe diarrhea and rectal tenesmus.

Intestinal motility disorders

With the denomination of Digestive motility disorders or bowel disease refers to various conditions in which the normal transit of stool is disturbed. They present with an obstructive syndrome and their etiology is very varied, as well as their manifestations.

Diverticulosis

Diverticulosis is a disease characterized by the formation of diverticula in the intestine. These are small pouches in the mucosa.

They don’t usually cause major problems until they become inflamed or infected, leading to diverticulitis. In such cases, the symptoms may include rectal tenesmus.

Irritable bowel syndrome

Irritable bowel syndrome is a condition in which there are episodes of diarrhea alternating with constipation, as well as pain (cramping) and rectal tenesmus. People who have this condition are sensitive to stress, as well as to changes in diet and certain medications that may trigger symptoms.

Anal abscesses

In anal or anorectal abscess or fistula, a pus-filled cavity forms in the region around the anus. Common symptoms of rectal tenesmus (pain during bowel movements, for example) are sometimes present, as well as lumps, bleeding, and secretions.

Colon cancer

The symptoms of colon cancer or colorectal cancer are non-specific. They include diarrhea, abdominal pain, rectal tenesmus and blood in the stool.

This is why it can be difficult to identify. It’s also why the best recommendation is to go for consultation at the signs to rule out or verify whether it is a common intestinal infection or a malignant process.

Hemorrhoids

With hemorrhoids, some patients may also experience that feeling of wanting to evacuate and that the intestines are still full, even after defecation. When a hemorrhoid prolapses through the anus, there’s irritation and severe pain.

Other causes

Aside from those mentioned, there are other causes that can lead to rectal tenesmus. These include stress, anxiety, and sexually transmitted diseases ( e.g., syphilis).

How is the diagnosis made?

A complete physical examination is performed to diagnose rectal tenesmus. First, the health care professional asks about symptoms, as well as bowel habits (frequency of bowel movements, amount and consistency of stool), including diet and other lifestyle issues.

In addition, blood tests and stool cultures are recommended. Various imaging tests are also performed, including radiography, abdominal CT scans, a colonoscopy and a proctosigmoidoscopy.

What is the recommended treatment for rectal tenesmus?

Treatment of rectal urgency will depend on the cause. In certain cases, medications of various types are required. This includes antibiotics or antiparasitics for intestinal or sexually transmitted infections.

The professional may also suggest corticosteroids, orally or rectally, as well as immune system suppressants to reduce inflammation.

For certain people, the use of laxatives may be recommended, especially in cases where rectal tenesmus is associated with intestinal motility problems or when constipation is present.

There are lifestyle measures to be taken into account. Among these are the diet to avoid refined flour, processed foods (sausages), and junk food.

The consumption of foods rich in fiber (fresh vegetables and fruits, legumes and nuts) is recommended. Also, adequate hydration and regular physical activity should always be maintained.

When to go to the doctor

Attention should be paid to certain symptoms, such as abdominal pain, rectal bleeding or bleeding in the stool, fever, nausea, and vomiting. If they occur persistently with tenesmus, it’s recommended to call the doctor to make an appointment as soon as possible.