Tenesmus

What is tenesmus?

Tenesmus is a constant feeling that you have to go to the bathroom, but you can’t. Even if you’ve just emptied your bowels or your bladder, it feels like you didn’t get everything out. Your body continues to urge you to go with symptoms such as pressure, pain, cramping and involuntary straining.

You can have tenesmus related to pooping or peeing. Rectal tenesmus is the persistent feeling that you need to poop, even when you can’t poop anymore. Vesical tenesmus is the persistent feeling that you need to pee, even when you can’t pee anymore. These are separate conditions with different causes.

Is it normal to have tenesmus?

Tenesmus is a symptom of an underlying condition. It shouldn’t be your normal everyday experience. If you have certain chronic gastrointestinal diseases, tenesmus can be more common, but it may be treatable. If tenesmus is new to you, it may be a sign of a new, acute condition that needs to be diagnosed.

What is tenesmus a symptom of?

Rectal tenesmus and vesical tenesmus are symptoms of different conditions.

Rectal tenesmus

Inflammation or constipation can cause rectal tenesmus.

Inflammation

The most common cause of rectal tenesmus is inflammatory bowel disease. Up to 30% of people with ulcerative colitis or Crohn’s disease experience some tenesmus. In these cases, rectal tenesmus is a side effect of chronic inflammation in the lower bowel. Your large bowel includes your rectum and anus.

Inflammation in your lower bowel will make it swollen and sensitive. There’s less room for normal poop passing through, which can make your bowel feel fuller, and the nerves that line your bowels are already irritated. These nerves may overreact, telling your brain or muscles that you need to clear your bowels.

Other conditions that can cause inflammation in your lower bowel include:

• Sexually transmitted infections, such as chlamydia.
• Endometriosis, if it spreads to your bowel.
• Colorectal polyps and tumors.
• Anal cancer.
• Radiation colitis from radiation therapy.
• Infectious colitis from a bacteria, parasite or virus.
• Diverticulitis.
• Celiac disease.
• Perianal abscess.
• Hemorrhoids.

Constipation

Constipation may also cause the feeling that you constantly need to poop even though you can’t. In this case, your bowels may not be empty, but you have trouble getting anything out, despite frequent efforts. Hard, impacted poop stuck in your bowel can irritate it, making it constantly want to evacuate.

Constipation has many causes, including:

• Diet and lifestyle factors, such as lack of fiber and exercise.
• Certain medications, such as pain relievers and antidepressants.
• Motility disorders that affect the nerves and muscles in your bowels.
• Large bowel obstructions.
• Irritable bowel syndrome.
• Pelvic floor dysfunction.

Vesical tenesmus

The feeling of frequently needing to pee even after you’ve just peed is caused by constantly activated peeing muscles. These muscles might be responding to residual pee left in your bladder. Or they might be overreacting to irritated nerves in your urinary tract if you have an inflammatory condition.

You may have residual pee in your bladder if you have a disorder that makes it hard to get everything out, such as:

• Bladder outlet obstruction.
• Neurogenic bladder.
• Bladder stones.
• Bladder prolapse.

Your urinary tract may be irritated and inflamed if you have:

• Urinary tract infection.
• Prostatitis (prostate inflammation).
• Vaginitis (vagina inflammation).
• Bladder cancer.
• Prostate cancer.

Is tenesmus related to stress or anxiety?

Tenesmus can certainly cause stress and anxiety, and they may also trigger it. While stress and anxiety aren’t enough to cause tenesmus, they can upset your nervous system and make it harder to control your muscles. This can help set the stage for the involuntary muscle contractions in tenesmus.

How do you treat tenesmus?

If you come to your healthcare provider with tenesmus, they’ll conduct some exams to try and isolate the cause. This might include:

• Digital rectal exam. Physical exam of your anus and rectum with lubricated gloved fingers.
• Anoscopy/flexible sigmoidoscopy. Investigation of your anus, rectum or lower colon with a flexible lighted scope.
• Colonoscopy. A more extensive investigation of your entire large intestine, using a colonoscope.

Once they have a better understanding of what’s causing your symptoms, they may treat your tenesmus in a few different ways, including:

• Treating the condition. If your tenesmus is caused by an acute condition that’s recent and treatable, your healthcare provider will treat the condition directly. That might mean antibiotics for an infection or prescription laxatives for severe constipation. Some conditions may require more aggressive treatment, such as surgery.
• Treating the inflammation. If inflammation is contributing to tenesmus by irritating the nerves in your tissues, your healthcare provider may want to treat the inflammation directly. They might prescribe anti-inflammatory medication such as corticosteroids or other specialty medicines designed to treat chronic inflammatory conditions.
• Treating rectal symptoms. Some anti-inflammatory and pain relief medications can be used topically inside of your anus and rectum to treat rectal tenesmus. You can insert them with a suppository. If you have inflammatory bowel disease, keeping up with your regular medications can also help keep symptoms like tenesmus from flaring.
• Targeting the muscles. Anticholinergics are drugs that block involuntary muscle movements. Providers often prescribe them to treat overactive bladder conditions, and they can help with both types of tenesmus. Your provider may also prescribe antispasmodics, or smooth muscle relaxers. Anticonvulsants can calm the nerves involved in tenesmus.
• Managing cancer symptoms. Tenesmus that’s caused by cancer can be difficult to treat. Cancer treatments such as radiation therapy and chemotherapy may not help and may actually cause tenesmus or make it worse. Your doctor might prescribe strong pain relievers in this case. Sometimes, surgery may help, depending on the type.

When should this symptom be treated by a doctor?

Always consult a qualified healthcare provider about tenesmus. Seek immediate care if you have:

• A fever.
• Nausea and vomiting.
• Severe pain.
• Blood in your poop or your pee.

A note from Cleveland Clinic

Whether it affects your bowels or your bladder, having a constant urge to go to the bathroom and an inability to do so is no way to live. You might feel reluctant to discuss these types of symptoms with a healthcare provider, but please don’t suffer in silence. Tenesmus is more than an inconvenience — it’s a sign of a condition that needs treatment. Even when the underlying condition is chronic and incurable, such as inflammatory bowel disease, treatment can help reduce the frequency and severity of your symptoms.