What is Tenesmus?

Reviewed by: HU Medical Review Board | Last Reviewed: July 2018.

Tenesmus is the feeling of needing to pass stool even when the bowels are empty. Sometimes referred to as “incomplete bowel movement,” tenesmus may be accompanied by a sensation of urgency and is a symptom of inflammatory bowel diseases (IBD) like Crohn’s disease and ulcerative colitis. Tenesmus may be a continuous or recurring sensation, and it can occur just after finishing a bowel movement. A person who is experiencing tenesmus may have multiple small bowel movements throughout the day. Tenesmus may occur with pain, cramping, straining, or other digestive symptoms.1,2

Tenesmus in people with IBD is most often caused by the inflammation in the colon (large intestine). IBD causes chronic inflammation in the colon, which may lead to tenesmus. IBD can also cause ulceration, narrowing, blocking, or scarring of the intestinal wall. These disturbances to the intestines can also contribute to tenesmus.2

What conditions can cause tenesmus?

Other conditions that may cause tenesmus include:

  • Rectal abscess
  • Colorectal cancer
  • Infection of the colon
  • Inflammation of the colon or rectum due to radiation therapy
  • Motility disorders of the intestines (which causes abnormal movement of food or waste)
  • Prolapsed hemorrhoid
  • Diverticular disease
  • Rectal gonorrhea
  • Irritable bowel syndrome1,2

How is tenesmus evaluated and diagnosed?

An individual who experiences tenesmus, whether continual or recurring, should be examined by a doctor to identify the cause of the symptom and prescribe appropriate treatment. Tests that are used to make a diagnosis may include:

  • Physical examination (including an abdominal and rectal examination)
  • Medical history (including the duration, frequency, and severity of symptoms and typical bowel habits)
  • Blood tests
  • Stool culture
  • Imaging of the abdomen, such as x-ray or computed tomography (CT) scan
  • Colonoscopy
  • Screening for sexually transmitted diseases1,2

In addition to tenesmus, individuals who experience any of the following symptoms should also report them to the doctor, including:

  • Blood in the stool
  • Abdominal pain
  • Chills or fever
  • Nausea or vomiting1,2

How is tenesmus treated?

Treatment for tenesmus is based on what is causing the sensation. If the tenesmus is due to IBD, treatment may include:

  • Anti-inflammatory medications, which may be taken orally or rectally
  • Immunosuppressants or immunomodulators
  • Biologic therapies
  • Corticosteroids
  • Antibiotics
  • Pain relievers2

Tenesmus that is associated with motility disorders may be treated by antibiotics or anti-parasitics. If constipation is the cause of tenesmus, patients may be treated with a laxative or advised to consume more fiber in their diet. Tenesmus that occurs with impacted stool (when the waste material gets stuck) may be treatment with a laxative enema or water irrigation.2

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