Tenesmus is a persistent urge to empty the bowels or bladder, even when they are already empty. This feeling is not a condition itself but a symptom of an underlying health issue. Individuals often feel uncomfortable pressure, pain, or cramping that compels them to strain, yet little or no waste is expelled. This persistent urge can cause significant discomfort.
Understanding Tenesmus
Tenesmus is a feeling of incomplete evacuation, characterized by a continuous, ineffective urge to defecate or urinate. Individuals might strain repeatedly, but only small amounts of stool or urine, or nothing at all, are passed. The sensation is often painful and may include involuntary straining. This feeling often stems from irritated nerves in the affected area, signaling a false need to eliminate waste.
There are two types of tenesmus, based on the affected system. Rectal tenesmus refers to the constant urge to have a bowel movement, even when the rectum is empty. Vesical tenesmus is the similar sensation of needing to urinate frequently, even after the bladder has been emptied. These types have different underlying causes and locations of discomfort.
Identifying the Causes
Rectal tenesmus arises from inflammation or irritation within the lower bowel. Inflammatory bowel diseases (IBD) such as ulcerative colitis and Crohn’s disease are common causes. This inflammation can make the bowel sensitive and reduce the space for stool, causing nerves to overreact. Other causes include infections (bacterial, viral, parasitic), diverticulitis, radiation proctitis from cancer treatment, and irritable bowel syndrome (IBS).
Colorectal cancer can also cause tenesmus, particularly if tumors are located in the rectum or sigmoid colon, leading to obstruction or nerve involvement. Growths or masses can press on tissues, creating a false sensation of fullness or blocking stool passage. Less common causes include anorectal abscesses, hemorrhoids, and scarring in the bowel from previous issues.
Vesical tenesmus, affecting the urinary system, results from conditions that irritate the bladder or interfere with its emptying. Urinary tract infections (UTIs) are a common cause, leading to frequent and intense urges to urinate. Other factors include interstitial cystitis, a chronic bladder wall inflammation, and physical obstructions such as bladder stones or tumors. Neurological conditions can also disrupt bladder control, contributing to the feeling of incomplete emptying.
Diagnosis and Management Strategies
Diagnosing tenesmus involves identifying its underlying cause. A healthcare provider will begin with a detailed medical history and a physical examination, which may include a digital rectal exam. Diagnostic tests can include stool cultures for infections, urine tests for UTIs, and blood tests. Imaging studies like CT scans or MRI may be used to visualize the abdomen and pelvis.
For colon issues, procedures like a colonoscopy or flexible sigmoidoscopy allow direct visualization of the bowel lining. If bladder issues are suspected, a cystoscopy might be performed to examine the inside of the bladder. Once the cause is determined, management focuses on treating that condition directly.
Treatment approaches vary widely based on the diagnosis. Infections are managed with antibiotics, while inflammatory conditions like IBD may require anti-inflammatory medications, immunosuppressants, or biologics. For constipation, increasing dietary fiber and fluid intake can be beneficial, though a low-fiber diet might be recommended during IBD flare-ups. Symptomatic relief measures may include pain management, antispasmodic medications to relax muscles, and in some cases, lifestyle adjustments like stress management and regular physical activity.
When to Seek Professional Medical Advice
Consult a healthcare provider if you experience persistent or worsening tenesmus. This symptom can indicate various underlying health issues that require medical attention. A professional evaluation is important to determine the precise cause and initiate appropriate treatment.
Certain accompanying symptoms warrant immediate medical attention. These include blood in the stool or urine, unexplained weight loss, severe abdominal pain, fever, chills, nausea, or vomiting. Any significant changes in bowel habits, such as new onset constipation or diarrhea, also necessitate prompt medical consultation. Seeking timely professional advice ensures proper diagnosis and can prevent potential complications.