From the Guidelines
Tenesmus is primarily caused by inflammation or irritation in the rectum, which can be due to various underlying conditions such as inflammatory bowel disease, rectal inflammation, colorectal cancer, or infections like dysentery, and can also be a symptom of opioid-induced constipation. The sensation of incomplete defecation or tenesmus can be triggered by nerve signals that create the sensation of fullness even when the bowel or bladder is empty. According to the American Gastroenterological Association Institute guideline on the medical management of opioid-induced constipation 1, opioid-induced constipation (OIC) occurs primarily via activation of enteric m-receptors, which results in increased tonic non-propulsive contractions in the small and large intestine, increased colonic fluid absorption, and stool desiccation.
Some key factors that contribute to tenesmus include:
- Inflammatory conditions such as inflammatory bowel disease
- Rectal inflammation or proctitis
- Colorectal cancer
- Infections like dysentery
- Opioid-induced constipation, which affects 40%–80% of patients taking chronic opioid therapy 1
- Other conditions such as irritable bowel syndrome, as suggested by the British Society of Gastroenterology guidelines for the management of the irritable bowel syndrome 1
The American Gastroenterological Association medical position statement on constipation 1 emphasizes the importance of a careful history and digital rectal examination to suspect defecatory disorders, which can be a cause of tenesmus. A thorough evaluation, including a physical examination and screening tests, is necessary to determine the underlying cause of tenesmus and guide appropriate treatment. Treatment options may include over-the-counter medications, prescription anti-inflammatory medications, suppositories, or antibiotics, depending on the underlying cause. It is essential to seek medical attention if symptoms persist or are accompanied by blood in stool, severe pain, or other concerning signs.
From the Research
Causes of Tenesmus
- Tenesmus, a feeling of incomplete defecation, can be caused by various factors, including inflammatory bowel disease (IBD) 2, 3, 4.
- IBD, which includes Crohn's disease and ulcerative colitis, is characterized by chronic inflammation of the gastrointestinal tract, leading to symptoms such as diarrhea, abdominal pain, and tenesmus 2, 3.
- Other potential causes of tenesmus include irritable bowel syndrome (IBS), which can cause similar symptoms to IBD, including abdominal pain, diarrhea, and tenesmus 5.
- In some cases, tenesmus can be a presenting symptom of a more serious condition, such as acute aortic dissection (AAD), which requires prompt medical attention 5.
- Loperamide, a medication commonly used to treat diarrhea, can also increase anal sphincter tone, which may lead to improvement of fecal continence in patients with and without diarrhea, potentially alleviating tenesmus symptoms 6.
Related Conditions
- Inflammatory bowel disease (IBD) is a chronic condition that can cause tenesmus, and its treatment typically involves a combination of medications, including aminosalicylates, corticosteroids, immunomodulators, and biologics 2, 3.
- Irritable bowel syndrome (IBS) is another condition that can cause tenesmus, and its treatment typically involves lifestyle modifications and medications such as loperamide 6, 5.
- Acute aortic dissection (AAD) is a life-threatening condition that can present with tenesmus as a symptom, and its diagnosis requires a high index of clinical suspicion and prompt imaging studies 5.