What to Do When You Experience Incomplete Bowel Movements

Dealing with the Symptom of Incomplete Evacuation

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The feeling of incomplete evacuation, in other words feeling like your bowel movement is incomplete, can be quite uncomfortable. In addition to the physical discomfort, incomplete bowel movements can cause you to feel quite worried - about what is going wrong or when you will need to be back in the bathroom.

The "feeling of incomplete evacuation" is a hallmark symptom of irritable bowel syndrome, (IBS), but you don't need to have IBS to experience this unpleasant symptom.

But considering how common IBS is, it is remarkable how little attention the symptom of incomplete evacuation gets from researchers. Thus not much is known as to what a person could do to reduce this discomfort. This article is offered as a way to try to fill in this information gap, with the hope that it will lead to some self-care strategies that you can try in an effort to reduce your symptoms.

What Is Incomplete Evacuation?

Incomplete evacuation is a subjective sensation that a bowel movement has not been as complete as it should be. When a person is constipated, the passage of small, hard stools may not leave the person with the sense that a full emptying has occurred. On the opposite side of the spectrum, people who suffer from chronic diarrhea may feel continued urges to defecate even after repeated bowel movements.

Why Does This Happen?

Again, there is not much known about the reasons behind this phenomenon.

Two physiological processes that have been identified as major underpinnings of IBS symptoms may be playing a role here. The first, visceral hypersensitivity, refers to a heightened pain sensitivity within internal organs -- in this case, the large intestine, the rectum and the anus. The second is motility dysfunction, the fact that the muscles of the digestive tract do not appear to be operating in a smooth manner, thus interfering with the ability to pass a comfortable, well-formed stool and feel as if you have had a satisfying complete bowel movement.

What's Supposed to Happen

In order to begin to directly address the problem of incomplete evacuation, it is essential to know what a "complete evacuation" is supposed to be. Stool matter makes its way along the entire length of the large intestine. Throughout this process, water is being absorbed from the stool, so that the consistency of the stool becomes firmer as it makes its way through the bowel. Although there is a great deal of variability, typically this stool matter moves into the sigmoid colon and rectum once or twice a day. Here, it is formed into a sausage-like shape in preparation to be passed comfortably out through the anus.

What to Do If You Have an Incomplete Bowel Movement Due to Constipation

For people who have constipation, the sensation of incomplete evacuation is directly related to actual physiology. Due to the difficulty in passing stool, it is likely that you have not fully emptied the rectum of stool, thus leaving you with feelings of dissatisfaction and discomfort.

Therefore, the primary way to address the problem is to try treatment options for relieving the underlying constipation. Increasing fiber, whether through diet, or with fiber supplements, is a good way to start.

Another good self-care strategy is to ensure that you have good bowel habits. Try to schedule a trip to the toilet the same time each day. For many people, biorhythms are such that urges for bowel emptying are strongest in the morning. Allow your body the time to empty as much stool as is possible, envisioning that rectum shape as you evaluate the "completeness" of the movement.

If you believe that dyssynergic defecation contributes to the difficulty in passing a complete stool, you may want to look into biofeedback or physical therapy as a way to ease your symptoms.

What to Do If the Problem Occurs with Diarrhea

The sensation of incomplete evacuation for people who experience chronic diarrhea is much more complex. Although known by the blanket term tenesmus, there is a glaring lack of research as to what causes this phenomenon when it occurs without any overt physiological cause. Due to the lack of clinical study, the following recommendations are offered purely as possible suggestions but are not based on any hard science.

Given our discussion that an "ideal bowel movement" involves emptying the rectum of stool matter, then one can see that when diarrhea is experienced, there is no physiological need to keep the bowels moving to "empty" themselves. Once stool emerges that is loose and watery, any firm stool that may have been residing in the sigmoid colon has certainly been passed. Yet, some nerve and motor dysfunction appear to be keeping the sensation of an urgency to empty very much alive.

In order to counteract this sense of urgency, it helps to remind yourself that no further stool really needs to come out. This type of thinking is often in direct contrast to what many people believe -- that emptying the bowels completely will prevent further diarrhea episodes. In fact, once the stool that is emerging is loose and watery, it is better to imagine the stool remaining in the rectum, where water can be drawn out so that the stool will be firmer for tomorrow's bowel movement. Keep in mind that there is no such thing as a truly empty bowel, as new stool is constantly being produced. In terms of the fear of future diarrhea episodes, remember that it is easier for the muscles of the anus to contain stool that is firm (i.e., has been "hanging out" and dried in the colon) than the watery stool that is emerging from higher up in the large intestine.

In response to urges to continue to empty, try the use of delay. Sit quietly in a spot near the bathroom and see if you can use relaxation exercises to calm your body until the sense of urgency passes without having to make another trip to the bathroom. Calming your body will also help to reduce any anxiety that might be causing the central nervous system to continue to send out impulses for further (unnecessary) emptying.

Sources:

Shim SE, Jones M, Prott GM, Morris LI, Kellow JE, Malcolm A. "Predictors of outcome of anorectal biofeedback therapy in patients with constipation" Alimentary Pharmacology and Therapeutics 2011 33: 1245-1251.

Torpy JM, Lynm C, Glass RM. Irritable Bowel Syndrome. JAMA. 2006;295(8):960.

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