Overview

Tenesmus is a condition where you get the urge to defecate or urinate despite having an empty bowel or bladder. It usually presents itself as an underlying symptom of some gastrointestinal conditions like Inflammatory Bowel Diseases (IBDs), Rectal Cancer, and Haemorrhoids. In this article, we will discuss various infectious agents that cause conditions leading to tenesmus.

Bacterial

Enteropathogenic Escherichia coli (E. coli)

These bacteria are a common cause of diarrhea in younger children in underdeveloped countries. While most strains are harmless and a part of the normal gut microbiome, some strains are pathogenic and can cause gastrointestinal diseases.¹ These pathogenic E. coli are called enteropathogenic (EPEC) E.coli. Symptoms from this infection can present themselves as fever and stomach cramps bloody diarrhea and tenesmus. These bacteria generally spread through contaminated food and water.²

Shigella species

These are a group of very infectious bacteria closely related to E. coli responsible for Shigellosis. They produce a toxin called Shiga toxin – a neurotoxin that disrupts the uptake of electrolytes, glucose and protein in the small intestine. Shigellosis usually initially presents as watery diarrhea, as the disease progresses, it is followed by dysentery along with bloody stools, stomach cramps as well as tenesmus. Similar to E. coli, they also usually spread through contaminated food and water, however, they are much more contagious and can also be spread through physical contact with contaminated persons and flies.^2,3

Salmonella spp

It is a family of bacteria that live inside many animals and cause a disease called salmonellosis. It is a common GI infection generally contracted by eating undercooked poultry or eggs and unpasteurised milk. The symptoms can include loose stools, stomach ache, nausea, headache, fever, lethargy and in some cases even tenesmus. The spread of the disease is exacerbated in places with poor hygiene hence, it is more common in developing countries.²

Campylobacter jejuni

These bacteria are also one of the major causes of bacterial diarrhea. Once contracted, it can cause ulcers in the small intestine and colon, along with inflammation and diarrhea. Usually, C.jejuni diseases are milder compared to other agents in this list, however it can still be fatal among young children and the elderly (over 65) since their immune systems are usually weaker than those of normal healthy individuals. The symptoms are usually similar to those of Shigella, diarrhea, abdominal cramps, fever and tenesmus,² but in some cases, it can trigger complications after the infection has past, e.g. reactive arthritis, which causes extreme pain in the joints due to inflammation and can last months.^4,5

Clostridiodes difficile

Unlike the others on this list, C.difficile isn’t usually contracted through external means. This bacterium is usually a part of the normal gut flora and is generally harmless. This organism becomes an issue in individuals who are already taking antibiotics. Your gut hosts a variety of organisms that aid with processes like digestion, however long doses of antibiotics can kill off many of the bacteria residing in it. If C.difficile manages to survive the onslaught of antibiotics, the environment becomes ideal for it to multiply even more and can cause disease.⁶ The symptoms include diarrhea (sometimes slimy), stomach ache, fever and in a few cases tenesmus. This disease is more prevalent among the elderly and those with weaker immune systems. People who have had C.difficile in the past are also at a higher risk of contracting this disease.^6,7

Yersinia enterocolitica

is a bacterium contracted by eating undercooked contaminated food, most commonly present in pork.⁸ Symptoms may include fever, stomach ache and bloody diarrhea. Sometimes the pain may be localised in the right side of the stomach and can be misdiagnosed as appendicitis. 

Viruses

many viruses can invade the gut, causing inflammation and ulcers that can lead to the individual experiencing tenesmus, some of them are as follows:

Herpes simplex virus (HSV)

It is a common sexually transmitted infection, usually affecting the mouth and genitals.⁹ However, in some situations, the virus can infiltrate the GI tract ,causing inflammation and ulcers in the bowels, this condition is commonly called herpes proctitis.¹⁰ This condition can present itself as rectal bleeding, painful bowel movements and tenesmus. This condition is usually associated with unprotected anal intercourse.

Cytomegalovirus (CMV)

It is an opportunistic virus that causes a condition called CMV colitis.It usually affects those with weakened immune systems, e.g., Cancer patients going through chemotherapy and HIV/AIDS patients.¹¹ This virus is transmitted through bodily fluids, although a healthy individual may be asymptomatic, however, if their immune system is compromised, the latent virus may become active and cause the disease. This virus causes inflammation, deep ulcers in the intestines and necrosis in the linings of the intestine. In more severe cases, haemorrhage and perforated bowels have also been reported. Common symptoms associated with this disease are bloody diarrhea, stomach ache and extreme cramps, fever, tenesmus and in severe cases even rectal bleeding.^2,11,12

Enteric adenovirus

There are multiple adenoviruses that affect humans, of them 2 have been identified to cause GI infections. Usually transmitted by eating contaminated food and coming into contact with contaminated surfaces, this disease is prevalent in places with poor hygiene practices and can be fatal for younger children. The symptoms include bloody diarrhea, tenesmus and dehydration.¹³

Parasite

Entamoeba histolytica

It is a protozoan parasite that causes amoebiasis (amoebic dysentery), a disease that affects the large intestine. The disease causes ulcers and inflammation in the intestine, which is followed by necrosis of intestinal tissues.¹⁴ The inflammation causes the feeling of tenesmus while the ulceration and necrosis cause bloody and slimy diarrhea which is usually associated with amoebic dysentery. Similar to most additions in this list, this pathogen enters the body through contaminated food and water, but it can also be spread by coming in contact with people having poor hygiene practices. This disease is one of the leading causes of mortality in young children, especially in underdeveloped areas of the world.^2,15

FAQs

How should I prevent infections that can cause Tenesmus?

Following proper hygiene practices like regularly washing hands and maintaining a sanitary environment is necessary. Always make sure that the water you are drinking coming from a safe source, having a water purifier may help. If it's not accessible for you, make sure to properly boil the water before drinking or storing it away to drink later. Avoid food that may look or smell suspicious.Most pathogens aren’t able to survive higher temperatures, so make sure any meat is cooked all the way through before eating.

Practising safe sex is also important for preventing many of these diseases.

When should I see the doctor?

Tenesmus is usually one of many symptoms that manifest when someone contracts any of these diseases, if you have the constant urge to use the loo along with stomach ache, diarrhea or fever then I would be highly recommended to go to the doctor. Even if there are no other symptoms, then it would be a good idea to visit the doctor.

Summary

Tenesmus is the constant urge to defecate or urinate despite having an empty bowel or bladder. It is usually an underlying symptom of a more serious gastrointestinal condition like rectal cancer, haemorrhoids and inflammatory bowel diseases. There are many infectious agents that can cause diseases that present with tenesmus as its symptom, some are as follows:

• Bacterial – E. coli, Shigella, C.jejuni, C.difficile and Y.enterocolitica cause Inflammatory bowel diseases leading to tenesmus
• Viral – Herpes simplex virus, Cytomegalovirus and Enteric adenovirus cause proctitis and colitis and more commonly affect immunocompromised individuals
• Parasites – Entamoeba Histolytica is a protozoa that causes amoebiasis and is a leading cause of infant mortality in underdeveloped countries

Most of these diseases spread due to poor hygiene conditions, so they are prevalent in poorer regions with dense populations.