Introduction 

Have you ever attempted to use the toilet but been unsuccessful? Do you feel pain, pressure, and a constant urge to use the toilet? If the answer is yes, you might have tenesmus. This symptom is usually associated with inflammatory conditions like Crohn's disease, ulcerative colitis, and infections. These conditions cause your digestive system to become inflamed, making you feel this way.

What causes Tenesmus?

You might wonder, “Why am I experiencing this, and how do I stop it?”

Well, inflammation in your intestines or rectum irritates the nerves that control bowel movements, causing tenesmus. Your brain receives conflicting messages from this irritation, which causes you to feel as though you need to pass stool even when there is nothing. It is similar to an ongoing false alarm.

How can you manage Tenesmus?

Tenesmus can be controlled, and the frequency of these symptoms can be decreased, by:

• Treating the Underlying disease: It is best to treat the underlying disease to eliminate this symptom
• Using Medications: Some medicines can reduce inflammation and ease this symptom
• Staying Active: Exercise supports your digestive health and reduces discomfort
• Adjusting Your Diet: What you eat can help or worsen the inflammation

Following these steps can reduce the frequency of tenesmus. Let's examine each step in more detail.

Treating the underlying condition

Tenesmus does not usually happen on its own. It results from an underlying condition like Crohn’s disease, ulcerative colitis, or even infections. These conditions cause your digestive tract to become inflamed. This, in turn, leads to symptoms like abdominal pain, diarrhoea, and that constant urge to use the toilet. You should note that tenesmus is not limited to just these conditions. Other inflammatory conditions, such as infections or even radiation-induced proctitis (inflammation of the rectum lining), can also cause it. It is important to treat the underlying condition first before managing this symptom. Your doctor will usually prescribe medications to treat the underlying condition. Here are some common types of medicines in managing inflammatory conditions:

• Aminosalicylates (5-ASAs): These medications, like mesalamine, reduce inflammation in the intestines. They are particularly used in ulcerative colitis
• Corticosteroids: Doctors use strong anti-inflammatory medicines like prednisolone during flare-ups but limit their use to short-term treatment
• Immunomodulators: These medications, such as azathioprine and methotrexate, regulate an overactive immune system, reducing inflammation over time
• Biologics: These advanced treatments, like infliximab, target specific parts of the immune system to control inflammation

Taking these medications as prescribed can help reduce inflammation, ease tenesmus, and make you feel much better.¹

When infections are the cause 

Sometimes, an infection in the rectum or anal area causes proctitis (inflammation of the rectum). This inflammation can lead to symptoms like a tenesmus, which is the feeling of needing to pass stool even when the bowel is empty. It can be caused by sexually transmitted infections (STIs) like gonorrhea, chlamydia, or herpes. Bacterial infections, such as Salmonella or E. coli, can also lead to tenesmus.

How are these Infections treated

If an infection is behind your tenesmus, your doctor may prescribe:

• A shot of ceftriaxone and a dose of azithromycin for gonorrhoea 
• Aithromycin or doxycycline pills for Chlamydia 
• Antiviral medications like acyclovir for herpes

Getting the proper treatment can clear the infection and ease your symptoms, so if you’re experiencing tenesmus along with pain, discharge, or bleeding, it is best to see a doctor as soon as possible.²

Using topical agents 

Doctors often start with oral medications to treat the underlying inflammation causing tenesmus. However, topical treatments can add extra relief, mainly when inflammation affects the rectum or lower colon. These treatments bring medication directly to the problem area, offering quick and targeted comfort.

A common choice is mesalamine suppositories or enemas. These medications calm inflammation in the rectum and lower colon, helping to ease the frustrating urge to pass stool. Studies show that mesalamine often works better than topical corticosteroids for managing inflammation in ulcerative colitis.

If oral and topical treatments do not fully relieve your symptoms, your doctor may suggest other options, such as biologics or immunosuppressants, to help you feel better.³

Adjusting your diet for symptom relief

What you eat is crucial in managing inflammatory conditions like Crohn’s disease and ulcerative colitis. Certain foods soothe your digestive system, while others worsen symptoms like tenesmus.

• Fibre: Research shows that a high-fibre diet can benefit people with Inflammatory Bowel Disease (IBD). Fibre supports your gut health by helping good bacteria grow, reducing inflammation, and improving how your bowels work. When fibre breaks down in your gut, it creates prebiotics, which feed the helpful microorganisms in your colon. Plus, fibre has anti-inflammatory effects that can help keep your IBD symptoms under control. 

However, too much fibre, especially insoluble fibre, during flare-ups, can worsen symptoms. In these conditions, it is best to:

• Choose Easier-to-Digest Options: Focus on peeled, boiled, or cooked vegetables and fruits. Remove skins and seeds from fruits and vegetables to reduce fibre intake
• Steam Vegetables: Steaming vegetables instead of boiling them retains nutrients while making digestion easier
• Limit Red Meat: Red meat promotes the release of inflammatory markers that worsen IBD symptoms, so reduce your intake

These adjustments can help ease discomfort and support your digestive health during flare-ups.⁴

Once the flare subsides, gradually reintroducing fibre helps restore gut health and maintain regular bowel movements. Since diet affects IBD differently for each person, working with a dietitian or healthcare provider can help you find the best dietary approach for managing symptoms.⁵

When the pelvic floor muscles affect bowel movements

While inflammation often causes tenesmus, some people with inflammatory bowel disease (IBD) also struggle to pass stool completely or smoothly because their pelvic floor muscles do not work well. These muscles help control bowel movements, but if they weaken or do not coordinate properly, you might feel strained or like you have not fully emptied your bowels.

The good news is, you can strengthen and retrain these muscles through pelvic floor muscle training (PFMT). This involves simple exercises, like squeezing and relaxing the muscles that control your bowel movements. By practising these exercises regularly, you can strengthen these muscles and improve how they work, making it easier to pass stool and reducing discomfort. Studies show that PFMT helps improve bowel function in people with IBD.⁶

When to seek medical attention for tenesmus

If you have an inflammatory condition like IBD, seek medical attention if you experience:

• Persistent or worsening tenesmus despite treatment
• Blood or mucus in stool, indicating inflammation or a flare-up
• Severe abdominal pain may signal complications like strictures or abscesses
• Fever or chills, suggesting infection or systemic inflammation
• Fatigue, weakness, or dehydration could point to anaemia or malnutrition
• New or unusual symptoms that deviate from your typical condition

If you are on immunosuppressive medications, watch for signs of infection. Early medical attention can prevent complications and ensure proper treatment adjustments.

FAQs

Why do I always feel like I need to go to the toilet even after I've already gone? 

Tenesmus is a sensation that occurs when an inflamed rectum or intestine sends the wrong signals to the brain. Common reasons include infections, haemorrhoids, and IBD. 

Does this have anything to do with my diagnosis of inflammatory bowel disease (IBD)? 

Yes, tenesmus is a typical IBD symptom, particularly during flare-ups. You constantly feel the need to use the toilet because your intestines are inflamed.

Why do I experience straining and discomfort even when passing small amounts of stool?

Straining and discomfort occur because inflammation or muscle coordination issues make it hard to empty the bowel fully. Pelvic floor dysfunction or rectal inflammation can also contribute.

What tests are needed to determine the cause of my tenesmus?

Your doctor may recommend stool tests, blood tests, imaging (like a CT scan), or a colonoscopy to check for inflammation, infections, or other issues, such as colorectal cancer.

How can I manage this symptom?

Managing tenesmus involves treating the root cause, using prescribed medications, adjusting your diet, staying active, and trying pelvic floor exercises. Topical treatments like suppositories can also help.

When should I seek immediate medical attention for tenesmus? 

Seek urgent care if you have a high temperature, profuse rectal bleeding, severe pain, or symptoms of dehydration. These could indicate a serious issue, like an intestinal blockage or an infection.

Summary 

Tenesmus, often linked to conditions like Crohn’s or ulcerative colitis, can disrupt daily life. You can ease symptoms by treating the root cause, using medications, adjusting your diet, and staying active. Seek help if symptoms worsen or persist. Work with your doctor to manage tenesmus effectively and improve your quality of life.