Introduction

Tenesmus is the frequent feeling or urge to pass stool or urine without being able to. Even though your bowels or your bladder are empty, your body continues to exhibit symptoms like involuntary straining, pressure, cramping and pain. This symptom is normally due to an underlying condition, and varies depending on the type of tenesmus.¹

Types of tenesmus 

Rectal tenesmus 

This type is linked to the bowels, so you would constantly feel the need to defecate. Inflammation or constipation are the common causes of rectal tenesmus.¹ 

Vesical tenesmus

Here, the bladder is affected, resulting in the frequent urge to urinate via the pelvic floor muscle being activated. The overactivation of the muscles may be due to residual urine in the bladder caused by disorders like bladder outlet obstruction, neurogenic bladder, and bladder stones. Another cause is irritated urinary tract nerves as a result of conditions like urinary tract infection, prostatitis, and vaginitis.¹  

Causes of tenesmus during pregnancy

• Gastrointestinal causes
  • Constipation due to hormonal changes

Due to the hormonal changes stimulated by pregnancy, constipation can often occur and some experience tenesmus.^2,3 This is most likely to happen during the third semester, but can also be experienced in the first and second trimesters as well as after birth.⁴

• Haemorrhoids

Haemorrhoids are swollen veins in, on or near your anus or inside your rectum. They affect about 30-40% of people assigned female at birth during pregnancy. Haemorrhoids in pregnancy are caused by the pressure of a growing fetus on the pelvic area and bowel, increased blood volume or constipation.⁵

• Irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD)

Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are two distinct disorders that can occur in pregnancy.^6,7

• Genitourinary causes
  • Urinary tract infections (UTIs) and bladder irritation

UTIs are another common presentation in pregnancy due to the anatomical and physiological changes that the body undergoes, which increases the risk of contracting these infections. There are different types of UTIs, and they affect different parts of the urinary system. ^8,9

• Interstitial cystitis (IC) 

IC, also called painful bladder syndrome, is a chronic condition presenting with pelvic pain, pressure and vesical discomfort lasting more than six weeks.¹⁰

• Mechanical factors
  • A growing uterus exerts pressure on the rectum and bladder, and pelvic floor dysfunction (PFD)

PFD can affect all experiencing pregnancy and is a result of the pelvic floor not functioning properly. This can lead to several different symptoms, including overactive bladder and constipation.¹¹ 

Diagnosis

A healthcare professional will conduct tests and exams to determine the cause of tenesmus. These include:¹

• Digital rectal exam –  a diagnostic physical exam of the anus and rectum with lubricated gloved fingers to check for any abnormalities like haemorrhoids¹²
• Anoscopy/flexible sigmoidoscopy – considered to be a partial colonoscopy as it examines the anus, rectum or lower colon using an extended, flexible tube with a lighted camera (an endoscope)¹³
• Colonoscopy – an investigation of the large intestine using an endoscope, which can be used for screening, diagnosis or treatment of a condition¹⁴

Management and treatment

Lifestyle & dietary modifications

Changing your lifestyle and diet can improve tenesmus, and modifications can include:^1,15

• High-fibre diet with fruits, vegetables and whole grains to ease constipation
• Regular exercising
• Having a toilet routine or improving toilet posture 

Medical treatments

Pharmacological treatments and supplements can also be used, such as:.^1,15

• Stool softeners 
• Soluble fibre or fibre supplements
• Pain relievers 
• Anti-inflammatory medications
• Anticholinergics
• Antibiotics 
• Antispasmodics
• Low-dose antidepressant drugs
• Anticonvulsants

• Pelvic floor therapy

Exercises to target, relax and strengthen the pelvic floor muscles are also normally recommended, and these exercises are:^1,15

• Kegel exercises 
• Physiotherapy for pelvic floor muscles

Options such as surgery are typically only for disorders which require aggressive treatments.¹

When to seek medical help

You should always seek help from a healthcare provider if you experience:

• Persistent or worsening symptoms 
• Blood in stool or urine
• Severe pain 
• Fever
• Nausea and vomiting

FAQs

Why do I feel like I have to poop but nothing comes out while pregnant?

This feeling is due to tenesmus, which is the sensation of incomplete bowel movements. During pregnancy, hormonal changes slow digestion, and the growing uterus can put pressure on the rectum, leading to constipation and difficulty passing stool. Haemorrhoids and increased progesterone levels can also contribute to this sensation.

What is the treatment for tenesmus?

Treatment depends on the underlying cause:

• If caused by constipation, increase fibre intake, drink plenty of fluids, and exercise
• If due to infection or inflammation (e.g., colitis, IBS, IBD), medications like antibiotics, anti-inflammatories, or immunosuppressants may be needed
• If related to haemorrhoids or rectal conditions, stool softeners or topical treatments can help

Can tenesmus go away on its own?

Yes, if it is caused by temporary factors like mild constipation or minor irritation, it can resolve with dietary changes and hydration. However, if it persists, it may indicate a more serious condition that requires medical attention.

Summary

Tenesmus during pregnancy is the persistent urge to pass stool or urine despite an empty bowel or bladder, often accompanied by cramping, pain, and involuntary straining. It can be classified into rectal tenesmus, which is associated with bowel issues like constipation and inflammation, and vesical tenesmus, which affects the bladder due to conditions such as urinary tract infections (UTIs), bladder stones, or neurogenic bladder dysfunction.

During pregnancy, hormonal changes often lead to constipation and haemorrhoids, increasing the risk of rectal tenesmus. Gastrointestinal conditions like irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) may also worsen symptoms. Genitourinary causes include UTIs, which are more common in pregnancy, and interstitial cystitis (IC), a chronic bladder condition causing persistent discomfort. Mechanical factors such as the growing uterus pressing on the rectum and bladder, along with pelvic floor dysfunction, can aggravate tenesmus.

Diagnosis involves physical examinations and tests such as digital rectal exams, sigmoidoscopy, and colonoscopy to test for signs and diagnose any underlying conditions. Management strategies include lifestyle and dietary modifications like a high-fibre diet, increased fluid intake, regular exercise, and proper toilet posture. Medical treatments may involve stool softeners, fibre supplements, pain relievers, anti-inflammatory medications, and antibiotics if infection is present. Pelvic floor therapy, including Kegel exercises, is also beneficial. In severe cases, surgical intervention may be necessary. 

Seeking medical attention is crucial if symptoms persist or worsen, or if there is blood in the stool or urine, severe pain, fever, nausea, or vomiting. Early diagnosis and appropriate management can significantly improve comfort and prevent complications during pregnancy.