From the Guidelines
The medical term for bowels not emptying completely is incomplete evacuation, also known as rectal tenesmus. This condition occurs when a person feels they haven't fully emptied their bowels after a bowel movement, often leaving a sensation of fullness or pressure in the rectum. Incomplete evacuation can be caused by various factors including constipation, irritable bowel syndrome (IBS), pelvic floor dysfunction, or inflammatory bowel diseases.
Key Points to Consider
- Incomplete evacuation is a symptom, not a disease, and its management depends on the underlying cause.
- The Rome III criteria define chronic constipation as the presence of any two of the following symptoms for at least 12 weeks in the previous 12 months: straining during bowel movements, lumpy or hard stool, sensation of incomplete evacuation, sensation of anorectal blockage or obstruction, manual evacuation procedures to remove stool, or fewer than 3 bowel movements per week 1.
- Treatment may include increasing dietary fiber intake to 25-30 grams daily, staying well-hydrated with 6-8 glasses of water per day, regular physical activity, and establishing a consistent bathroom routine.
- Over-the-counter options like psyllium husk (Metamucil) taken 1-2 teaspoons daily mixed with water or docusate sodium (Colace) 100mg once or twice daily may help soften stool.
- Pelvic floor physical therapy can be beneficial if the issue stems from muscle coordination problems, as noted in the management of defecatory disorders 1. The condition occurs because proper bowel emptying requires coordination between abdominal muscles, pelvic floor relaxation, and rectal sensitivity, and disruption in any of these mechanisms can lead to the sensation of incomplete evacuation. According to the most recent guidelines, management should focus on addressing the underlying cause and improving bowel habits 1.
From the Research
Definition of Bowels Not Emptying Completely
The medical term for bowels not emptying completely is referred to as:
- Dyssynergic defecation: a condition where there is a paradoxical contraction or failure to relax pelvic floor muscles when straining to defecate, leading to incomplete evacuation of fecal material from the rectum 2.
- Obstructive defecation: a condition characterized by difficult evacuation, hard stool, and a feeling of incomplete emptying, often associated with pelvic floor disorders 3, 4.
Characteristics of Dyssynergic Defecation
Dyssynergic defecation is a common form of functional constipation, defined by:
- Incomplete evacuation of fecal material from the rectum due to paradoxical contraction or failure to relax pelvic floor muscles when straining to defecate 2.
- No associated morphological or neurological abnormalities, making it a behavioral disorder 2.
- Often treated with biofeedback therapy, which involves teaching patients how to relax pelvic floor muscles when straining to defecate 5, 2.
Diagnosis and Treatment
Diagnosis of dyssynergic defecation and obstructive defecation can be made through:
- History and physical examination 4.
- Prospective stool diaries and anorectal physiologic tests 5.
- Colonic transit time, balloon expulsion test, proctography, anorectal manometry, and electromyography 4. Treatment options include:
- Biofeedback therapy, which has been shown to be effective in adults with dyssynergic defecation 5, 2, 3.
- Medical treatment, such as laxatives and prokinetics 6.
- Surgical treatment, which may be indicated in refractory cases or when anatomical alterations are present 4.