The feeling of not having completely evacuated

Have you ever experienced that nagging feeling of not being able to empty completely during evacuation?

Do you often experience a feeling of bloating and bowel heaviness while regularly providing daily defecation?

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Tenesmus is the medical name of a condition that, contrary to popular belief, can afflict even perfectly healthy people without obvious intestinal disease.

Read this page written by Dr. Luisella Troyer to find out what tenesmus is, when it occurs, and what can be done to treat it.

What is rectal tenesmus?

In Medicine, rectal tenesmus is defined as the sensation, reported almost always as extremely unpleasant, that prompts the urge to defecate, but without, however, reaching evacuation.

Alternatively, evacuation may be there, but it is perceived by the subject as unsatisfactory, of small quantity, and still leaving the sensation of not completely emptying the intestinal ampulla.

Sometimes, the urge to defecate is constant throughout the day, thus giving no respite to the patient who never, however, manages to satisfy it with complete and sufficient evacuation.

What is rectal tenesmus caused by?

Rectal tenesmus is caused by an abnormal contraction of the sphincter muscles, actual spasms, which simulate the normal stimulus of a full ampulla and thus prompt the patient to search, ineffectively, for evacuation.

In turn, these sphincter spasms are a symptom of an upstream problem of intestinal or proctological origin.

Some of the most common causes of rectal tenesmus include:

• Irritable bowel syndrome;
  
• Episodes of anxiety and poorly managed stress;
  
• Parasitic and bacterial infections such as chlamydia and gonorrhea;
  
• Spastic colitis;
  
• Ulcerative rectocolitis;
  
• Chronic constipation never treated;
  
• Proctitis and anitis;
  
• Anal fissure;
  
• Colorectal cancer and cancer of the anus;
  
• In women, rectocele and cervical cancer.

These pathologies, or otherwise pathological conditions, are only a small part of the causes that can lead to tenesmus.

What are the symptoms of tenesmus?

Tenesmus is itself a symptom, and manifests itself as the inability, albeit in the presence of stimulus, to perform complete and satisfactory defecation.

Patients with tenesmus often complain how, even after the act of defecation, it is impossible or very difficult for them to feel their intestinal muscles relaxed, thus manifesting, even without needing to, the urgency to defecate.

Sometimes, this sensation is accompanied by abdominal cramping and pain, meteorism and flatulence, and, in the case of proctitis and anitis, often also by anal burning and itching.

How is anal tenesmus diagnosed?

The diagnosis of tenesmus is clinical, and is made by the Proctologist Physician during the specialized proctological examination.

Even at the history stage, the symptoms reported by the patient put the Physician on the right track, directing the Clinician to the right diagnosis.

Nevertheless, proctologic examination is always necessary, more so to investigate the cause of tenesmus, which may originate from a proctologic problem that was never resolved or otherwise underestimated over time.

How is rectal tenesmus treated?

The treatment of rectal tenesmus is, playfully, linked to the treatment of the cause that creates the sphincter hyper-spasm.

The patient's medical history should be thoroughly investigated, and the entire colon should sometimes be examined (by colonoscopy) to make sure there are no polyps or cancerous lesions that could be the root of the problem.

In case of a lack of physiological reasons, it is imperative to investigate, also with the support of a Psychologist, any psychological issues of the patient, since many proctological diseases (such as irritable bowel syndrome) have their psychosomatic origin.

Which Physician can diagnose and treat rectal tenesmus?

The clinical specialist with great experience in all diseases of the rectum and anus is the Proctologist Physician.

Therefore, it is to him that one should turn when experiencing the symptom of rectal tenesmus, and it is to him that one should seek a specialized proctological examination.