Overview

Tenesmus is a sign or symptom of an underlying disease condition. Tenesmus is more common when a person is suffering from acute or chronic gastrointestinal disease and the nerves are being affected.

Tenesmus is a constant feeling of urge to go to the bathroom without being able to go. Severe inflammation of the nerves related to the gastrointestinal tract causes the urge to pass stool (poop) and urinate (pee) more often, accompanied by symptoms like pressure, pain, cramping and straining efforts.

Rectal tenesmus is the condition where there is a persistent feeling to pass stool even when there is no stool (poop) to pass. Vesical tenesmus is the condition where there is a persistent feeling to urinate (pee) even when there is no more to pee.

Understanding Tenesmus

Tenesmus is a constant feeling to evacuate the bowels, with little or no stool or urine to pass. It can occur with diseases that can affect the normal movements of the intestines. Normally the gastrointestinal tract functions like this when the food passes from the stomach to the small intestines all the nutrients are absorbed there and the rest of the food residue is passed into the large intestine (colon, rectum and anus). In the colon, most of the water content is absorbed from the food residue and the remaining residue is eliminated from the intestine as faeces (stool). People with tenesmus try harder to push or strain to empty the bladder or intestines even if there is only a small amount of stool to pass.

Causes of Tenesmus

Tenesmus is a symptom of different underlying health conditions. There is rectal tenesmus (constant feeling to pass the stool) and vesical tenesmus (constant feeling to empty the bladder).

Rectal tenesmus

Rectal tenesmus is the persistent feeling of passing stool and is caused mainly due to inflammation or constipation.

Inflammation: The disease conditions that can cause inflammation in the bowels are:

• Inflammatory bowel disease (IBD): It is a group of disorders that causes chronic inflammation, pain and swelling in the intestine. The symptoms can be mild and gradually become severe, there may be continuous diarrhoea (loose stool), bloating sensation, loss of appetite, unexplained weight loss and blood in stool.
• Ulcerative colitis: It is an inflammatory bowel disease that causes inflammation and ulcers in the digestive tract. It affects the innermost lining of the large intestine. Symptoms get worse over time, it includes diarrhoea, cramping, tiredness, nausea, weight loss, blood in stool and anaemia (decreased number of red blood cells).
• Crohn’s disease: It is an inflammatory bowel disease which causes inflammation and irritation in the digestive tract. It can cause symptoms like diarrhoea, cramps, loss of appetite, weight loss, rectal bleeding, anal fistula and mouth sores. Crohn’s disease can be painful and can lead to life-threatening complications.
• Sexually transmitted diseases (STDs): Sexually transmitted diseases are highly contagious infections that can be passed on to other people while involved in sexual activity of any kind. Sexually transmitted diseases are serious illnesses which need treatment and some diseases like human immunodeficiency virus (HIV) have no cure and they can be life-threatening. Mostly they do not have any symptoms but in severe conditions, there may be sore throat, swelling and itching near the vagina or penis, skin rash, diarrhoea and weight loss.
• Colorectal polyp or tumour: Colorectal polyps are the growth of a tumour, a cluster or mass of abnormal cells in the inside lining of the colon (large intestine). Colon polyps are mostly harmless but they can grow into cancer if not removed. The main symptoms are colorectal bleeding, constipation and diarrhoea.
• Chlamydia: Chlamydia is the most common sexually transmitted infection by bacteria. Anyone can get chlamydia from intercourse, anal sex or oral sex because they do not have any particular symptoms. They are treatable and curable.
• Endometriosis: Endometriosis is a condition where the growth of tissue similar to the lining of the uterus occurs on other parts of the body. When it grows in other areas of the body it causes sensitivity and inflammation during menstruation.
• Anal cancer: It is known as anal canal carcinoma where it develops in the lining of the anal canal. The anal canal is the part between the anus and the rectum. It shows symptoms like rectal bleeding and pain. It is treated and managed by chemotherapy and radiation.¹
• Infectious colitis: The colon is the main part of the large intestine, colitis is the inflammation of the colon caused by infection or injury. It causes pain, diarrhoea, blood in stool, swelling and tenderness in the tissue.
• Diverticulitis: Diverticula is the tiny pockets in the lining of the colon, which can get infected and inflamed (diverticulitis). Chronic diverticulitis causes scarring. Diverticulitis can cause abdominal pain, distended abdomen, fever, nausea, rectal bleeding and constipation.
• Perianal abscess: Perianal abscess is a boil-like lump filled with pus found near the anus. It occurs when the anal glands get clogged or infected, it leads to pus and fluid collection. There will be pus-like discharge from the anus, pain, rectal bleeding, boil and constipation.
• Haemorrhoids: Haemorrhoids (piles) are swollen veins inside or outside the anus or rectum. It can be uncomfortable, and painful and can cause rectal bleeding.

Constipation: Constipation occurs when bowel movements are not frequent and stools become difficult to pass. It happens when there is a change in diet or routine, or due to inadequate intake of water and fibre. Constipation makes the stool harder and more painful to pass, as stomachache, and bloatedness. Constipation can occur due to many reasons, such as changes in diet and exercise, certain medications and disease conditions like irritable bowel syndrome (IBS).⁴

Vesical tenesmus

Vesical tenesmus is the condition where a person feels to urinate immediately after urinating. This occurs when the bladder muscles respond to the residual urine left in the bladder or when there is a nerve involved due to the inflammation. This can occur due to these disease conditions : 

• Bladder outlet obstruction: It is a condition where the neck of the bladder gets blocked, it makes the urine flow slow and sometimes blocks the urine flow. This may be due to scar tissue, bladder stones, cancer or tumour.⁵
• Bladder calculi (bladder stones): Bladder stones are the hardened mineral deposits that form in the bladder from the urine which remains in the bladder even after urinating (peeing). Smaller stones do not show any symptoms and they are passed out while passing urine. Larger stones are painful, there will be blood in urine, and frequent urge to urinate.
• Bladder prolapse: Cystocele is a condition where the supportive ligaments and muscles around the bladder and vagina are weakened and cause the bladder to bulge into the vagina.
• Urinary tract infection: Urinary tract infection is an infection of the urinary system due to bacteria. It causes pain while urinating, fever, chills and inflammation in the lining of the urinary tract.
• Prostatitis: The prostate is a gland which is a part of the male reproductive system and people are assigned male at birth. Prostatitis is a condition associated with inflammation. Bacterial infection causes some prostatitis. It causes difficult and painful urination, and pain in the groyne, pelvic and genital area. 
• Bladder cancer: It is a rare type of cancer that starts from the lining of the bladder.
• Vaginitis: Vaginitis is a condition caused by different disorders that cause the inflammation of the vagina. It is caused by bacteria, yeast or any viruses. It causes thick white vaginal discharge, itchy and burning sensation while urinating.
• Prostate cancer: Prostate cancer develops in the prostate gland, which is a walnut-shaped gland located below the bladder in men and people assigned male at birth.²

Symptoms

Some of the common symptoms are : 

• Frequent feeling of emptying the bowels even though they have passed the stool just before.
• Frequent feeling to urinate even after urinating just before.
• Abdominal pain
• Blood in stool and urine
• Nausea 
• Vomiting
• Fever

Diagnostic methods

The healthcare provider asks for the medical history of the patient and does a detailed abdominal examination. The tests done are : 

• Digital rectal examination: It is a test to examine the lower rectum and anus. The health provider inserts gloves in the hand and lubricates the fingers, then the examiners insert the finger into the anus to the rectum and check for any abnormalities.
• Colonoscopy: It is an examination to view the inside of the colon using a tool called a colonoscope, where a small camera is attached to the tube to view the entire large intestine.
• Complete blood count: It is a blood test used to diagnose numerous diseases.
• MRI: This imaging technique gives a clear picture of the area of affection.³
• CT scan (Computed tomography): This scan gives the physician a detailed cross-sectional 3D picture of the internal organs.
• X-ray: This gives detailed images of the organs.
• Stool culture: It is a lab test to find any organisms in the stool that can cause any gastrointestinal diseases.

Treatment and Management

Tenesmus is a symptom of an underlying disease condition so the treatment is given according to the main disease condition. The physician might prescribe antibiotics for the infection and laxatives for severe constipation.

FAQs

How do I know if I have tenesmus?

Tenesmus is a feeling of passing stool or urine even though you have emptied already. It is a symptom of an underlying disease condition. It occurs with cramping pain, straining and bloatedness.

When should I consult a doctor?

Always consult a doctor when you have fever, nausea, vomiting, abdominal pain, rectal bleeding and urgency to pass urine or stool even though emptied before.

How to treat tenesmus at home?

Tenesmus should be properly diagnosed and treated by a doctor. But it can be managed at home by following these: 

• Having a properly balanced diet
• Proper regular exercise
• Adequate water

How long does tenesmus last?

Tenesmus is a sign or symptom of an underlying disease condition, it will last for weeks or months depending on the actual disease.

Summary

Tenesmus is a constant feeling of urge to go to the bathroom without being able to go. Severe inflammation of the nerves related to the gastrointestinal tract causes the urge to pass stool (poop) and urinate (pee) more often, accompanied by symptoms like pressure, pain, cramping and straining efforts. Rectal tenesmus is the condition where there is a persistent feeling to pass stool even when there is no stool (poop) to pass. Vesical tenesmus is the condition where there is a persistent feeling to urinate (pee) even when there is no more to pee. Tenesmus is a symptom of an underlying disease condition so the treatment is given according to the main disease condition. The physician might prescribe antibiotics for the infection and laxatives for severe constipation.