Tenesmus: The Constant Urge to Defecate

Introduction:

Tenesmus is an intense urge to pass stools even when the bowel is empty. The urge accompanies straining and discomfort during bowel movements. Despite the difficulty, only small amounts of stool are released from the body. Various gastrointestinal diseases like inflammatory bowel diseases, irritable bowel syndrome, infections, and colon cancer symptoms cause tenesmus. Read this article to learn more about tenesmus and how it is diagnosed and effectively managed.

What Causes Tenesmus?

Tenesmus Is a symptom seen in certain diseases of the gastrointestinal tract. The various conditions include

• Stress or Anxiety - Both stress and anxiety trigger tenesmus and upset the nervous system making it difficult to control the muscles.

• Constipation - It s the constant feeling of pooping but an inability to do so. It is caused due to lack of exercise and fiber content in foods.

• Ulcerative Colitis - It is an inflammation of the digestive tract.

• Crohn's Disease - It is a swelling in the digestive tract, leading to abdominal pain, malnutrition, and weight loss.

• Irritable Bowel Syndrome - It is a disorder that affects the gastrointestinal tract and causes symptoms like constipation, abdominal pain, and cramping.

• Proctitis - It is inflammation of the rectal lining caused by inflammatory bowel disease or sexually transmitted infections.

• Sexually Transmitted Infection (STI) - It is an infection of the rectum caused by organisms like chlamydia.

• Infections - Parasitic bacterial or viral infections of the colon area.

• Surgeries - Due to certain abdominal surgery.

• Motility Disorders - These are diseases that affect normal intestinal movements.

• Rectal Abscess - It is an infection that causes a pocket of pus. An anorectal abscess develops in the anus region and causes swelling, a feeling of pressure, and pain. Conditions like anal fissures, diabetes, inflammatory bowel disease, and certain sexually transmitted infections increase the risk of this abscess.

• Colorectal Cancer - Itleads to polyps or tumor growth in the rectal region. The pressure which develops from these growths causes the symptoms of tenesmus.

• Cancer Treatment - Radiation therapy, can cause inflammation in the colon or rectum region leading to tenesmus.

Both Crohn's disease and ulcerative colitis are types of inflammatory bowel disorders that commonly cause tenesmus. These two conditions cause ulceration in the gastrointestinal tract (GI), leading to scarring. The scaring of the GI tract makes it difficult to pass stools, causing symptoms like tenesmus.

What Are the Symptoms Seen in Tenesmus?

The symptoms seen in tenesmus include:

• Constantly feeling the need to pass stools.

• Discomfort, cramping, and intense straining during bowel movements.

• Passing very small amounts of stools despite the straining.

• Feeling as if the bowel still needs to be emptied.

When Does Tenesmus Require Management?

If symptoms like blood in the stool, abdominal pain, fever, chills, nausea, and vomiting occur, it is important to notify the healthcare practitioner and obtain appropriate care.

How Is Tenesmus Diagnosed?

To diagnose the condition, the doctor will perform a detailed physical examination and enquire about the symptoms that the patient experiences, like weight loss or blood in the stools. The doctor will also do a few other tests to diagnose the condition. They include the following:

• Blood tests like complete blood count (CBC).

• Stool samples are assessed to check for any underline infection.

• Culture from the rectum is taken if STIs are suspected.

• Imaging studies like X-rays, magnetic resonance imaging (MRI), or computer tomography (CT) are done to get a detailed view of the abdominal pelvic area.

• Proctosigmoidoscopy is an examination done in the lower bowel region, like the rectum, lower colon, and anus region, using a light scope.

• Colonoscopy is done to visualize the rectum and colon area.

• Anorectal manometry is a noninvasive procedure to check the functioning of anal and rectal muscles.

How Can Tenesmus Be Treated?

Tenesmus can be treated by appropriate lifestyle modifications and through medical intervention.

1) Lifestyle Modification:

• Diet Changes - High fiber diet is always recommended to relieve tenesmus caused by constipation or irritable bowel syndrome. People should consume at least 20 grams of fiber daily to make the stools lighter and help them pass easily out of the body. However, if tenesmus is due to inflammatory bowel disease, certain high-fiber diets can trigger the symptom, causing a flareup, so it is important to note the condition causing tenesmus to avoid the trigger foods.

• Keep Well Hydrated - Drinking more water can help soften the stools. At least three littles of water is required daily for men, and women should consume at least 2.7 liters of water daily.

• Exercise - While exercising, physical activity stimulates intestinal movements. These movements will help the intestine move the waste through the gastrointestinal tract, especially in constipation or inflammatory bowel syndrome cases.

• Training the Bowel Movements - The healthcare practitioner usually recommends bowel training if tenesmus is caused by constipation. The training involves setting a proper time for bowel movements daily, usually after an hour of eating breakfast, giving enough time while using the bathroom, trying to relax the muscles while passing stools, and using the restroom whenever an urge occurs.

2) Medical Interventions:

• Constipation - Laxatives, stool softeners, and fiber supplements are given for constipation.

• Infections - If tenesmus is caused due to STI infections or infections of the gastrointestinal tract, the doctor will start the patient on a course of antibiotics. However, in viral infections, antibiotics do not work.

• Rectal Symptoms - To treat rectal tenesmus, pain relief medications, and anti-inflammatory medications are topically used inside the anus or rectum region. They can also be inserted with a suppository.

• Inflammatory Bowel Disease - The medical management of IBD mainly involves stopping the inflammation causing the symptoms. The first line of treatment involves anti-inflammatory medications like corticosteroids and aminosalicylates that are given to reduce inflammation. Medications like biological therapies or immunomodulators, which reduce immune system activity, are also used to treat inflammatory bowel disease. In a complex IBD case, antibiotics are given as a last resort.

• Rectal Prolapse - Tricyclic antidepressants effectively treat tenesmus in persons with rectal prolapse. However, the ideal treatment for rectal prolapse is surgery.

• Cancer - Tenesmus caused by cancers are usually difficult to treat. When cancer is treated with radiation therapy and chemotherapy, it usually causes tenesmus and worsens it. In such cases, the doctor might recommend strong painkillers, and, in some conditions, even surgical intervention is recommended.

Conclusion:

Tenesmus is a feeling to pass stools even when the bowels are empty; it involves severe cramping, pain, and involuntary straining. Tenesmus is a sign of underlying health conditions, so if it occurs frequently, always consult a doctor to diagnose the condition causing it. By diagnosing the conditions, appropriate treatment will be given, which will help reduce the severity and frequency of the symptoms.