What Is Tenesmus?

Tenesmus is a symptom of many bowel and digestive conditions

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If you have an inflammatory bowel disease such as Crohn’s or a similar condition, you’re probably familiar with tenesmus, even if you’ve never heard the term. Tenesmus is the feeling that you need to empty an already empty bowel or bladder. It usually involves repeated straining and abdominal cramping, or a sensation of incomplete evacuation, that is, the feeling that there’s still stool or urine to be passed.

Even if the bowel movement is productive, it may only result in a few small, hard stools. 

When the word tenesmus is used as a stand alone term it usually refers to rectal tenesmus. Bladder tenesmus is also known as vesical tenesmus.

Symptoms of Rectal Tenesmus

Rectal tenesmus is associated with a variety of medical conditions, including anorectal or colorectal abscesses or tumors, gastroenteritis, infectious colitis, diverticular disease, celiac disease, and  proctitis from radiation treatment

For people with ulcerative colitis and Crohn's disease, rectal tenesmus is an unfortunately common occurrence. It's is also seen in many people who have irritable bowel syndrome (IBS), both IBS-C, where constipation is another major symptom, and IBS-D, where diarrhea is more prevalent.

Since both Crohn's and ulcerative colitis cause ulceration in the gastrointestinal tract, it's more likely that people with those conditions may have scarring in their colon, rectum or intestines as a result.

Such scarring can make it more difficult to pass a bowel movement, which may lead to the straining of tenesmus. 

Treatment for Rectal Tenesmus

The most effective treatments for tenesmus will vary depending on the underlying condition. One small clinical trial found that low dose tricyclic antidepressants improved tenesmus symptoms in some patients.

There's a great deal of research showing a connection between the brain and gut function, and how closely the two affect each other, so it makes sense that an antidepressant might provide relief of tenesmus. But this is something to discuss with your healthcare provider since antidepressants have their own side effects to consider. 

If your tenesmus is a symptom of a gastrointestinal infection or inflammation, such as diverticulitis, antibiotics may be necessary. 

Often, however (and again depending on the underlying cause), tenesmus is a symptom that can be relieved by drinking more water or adding fiber to your diet. Since it's often a secondary symptom of poor gut motility, anything that gets the digestive process moving better is likely to help ease tenesmus. 

What Is Vesical (Bladder) Tenesmus?

Vesical tenesmus is the experience of feeling a continued need to urinate even when the bladder has been emptied. The symptom may accompany the acute problem of a urinary tract infection (UTI) or the more chronic condition of interstitial cystitis

As with rectal tenesmus, treatment of the underlying cause of vesical tenesmus should help to ease the symptom. 

What to Do If You Have Tenesmus

While it may be embarrassing to talk about tenesmus, since it usually indicates an underlying condition, it's important to mention it to your healthcare provider.

He or she can then work to identify what might be causing the symptom and get you started on an appropriate course of treatment. 

Sources:

Livovsky, D., et. al. "Tricyclic antidepressants for the treatment of tenesmus associated with rectal prolapse" Colorectal Disease 2015 17:1094–1099.

Meerveld BG-V, Johnson AC, Grundy D. "Gastrointestinal Physiology and FunctionHandbook of Experimental Pharmacology. 2017. 

Ford, A., Sainsbury, A."Treatment of irritable bowel syndrome: beyond fiber and antispasmodic agents" Therapeutic Advances of Gastroenterology March 2011

"Tenesmus" The New York Times.

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