The Troubling Symptom You Can’t Ignore
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It’s a worrying and bothersome sensation — frequently having the urge to go to the bathroom, even though your bowels are empty. If you have an inflammatory bowel disease like Crohn’s disease or ulcerative colitis, you may be all too familiar with this symptom, which is called tenesmus. A review published in August 2019 in the World Journal of Gastroenterology noted that 37 percent of people with IBD suffer from tenesmus or a similar form of fecal incontinence, affecting their physical, social, and emotional well-being.
Tenesmus is difficult to ignore, and running to the bathroom repeatedly “affects quality of life significantly,” says Adam Ehrlich, MD, an associate professor of medicine at the Lewis Katz School of Medicine at Temple University in Philadelphia and a co–medical director of the inflammatory bowel disease program at Temple University Hospital.
Read on to learn about the symptoms of this uncomfortable condition and how you can treat it.
Symptoms of Tenesmus
Both ulcerative colitis and Crohn’s disease can cause inflammation of the rectum, known as proctitis, which gives people the “false sensation, or urge, of having to move their bowels even when there isn’t stool in the rectum,” says Paul R. Sturrock, MD, a colon and rectal surgeon at UMass Memorial Medical Center in Worcester, Massachusetts. Tenesmus can also be associated with abdominal cramps and rectal pain, per MedlinePlus.
“Often patients will describe having multiple small bowel movements over the course of the day as they repeatedly go to the bathroom to try and evacuate and relieve the urge they are feeling,” says Dr. Sturrock.
As an inflamed rectum expands and contracts, even a little amount of stool, or even gas, can create the sensation of needing to have a bowel movement, says Dr. Ehrlich. People often feel like they’re going to have an accident if they don’t make it to the bathroom immediately. When they get there, “not much of anything comes out, and [the effort] is sometimes uncomfortable.” People may also experience mucous discharge from the anus.
What Causes Tenesmus?
Anything that causes rectal inflammation can lead to tenesmus. According to the Cleveland Clinic, hemorrhoids, colorectal polyps or tumors, anal cancer, endometriosis that has spread to the bowel, perianal abscesses, and diverticulitis can all cause the rectum to become inflamed. People who have a sexually transmitted disease, such as chlamydia, may also experience tenesmus, as well as men who have received radiation therapy to the rectal area for prostate cancer.
Tenesmus is especially common in people with ulcerative colitis. “By definition, ulcerative colitis starts in the rectum and moves up the digestive tract,” explains Ehrlich. “So nearly all patients with colitis and an inflamed rectum are at risk of tenesmus as a symptom if they have not yet been treated for their IBD.”
In people with Crohn’s disease, the most common area of inflammation is the ileum, or the lowest part of the small intestine, so they are less likely to experience tenesmus, says Ehrlich.
Treatment for Tenesmus
If you stay on top of your disease and use a good maintenance medication regimen prescribed by your gastroenterologist, you may prevent rectal inflammation from becoming severe enough to cause tenesmus, says Sturrock.
If the symptom does develop, doctors may prescribe topical therapies that patients can insert such as a suppository into the rectum, says Ehrlich. These include aminosalicylate (5-ASA) drugs, most commonly mesalamine. Mesalamine can also be given through a self-administered enema.
Gastroenterologists may also prescribe steroid suppositories, such as hydrocortisone in a foam that can be inserted into the rectum to reduce inflammation. Another medication, called budesonide, is also available in a suppository foam; it can reduce rectal inflammation and is effective for patients who did not respond to or could not tolerate topical and oral aminosalicylates, according to a review published in July 2019 in Expert Reviews of Gastroenterology & Hepatology.
In addition, doctors may recommend oral 5-ASAs to manage your overall IBD, which can help to relieve tenesmus, says Ehrlich. People who have more severe disease may benefit from biologic therapies like infliximab (Remicade).
Although doctors may recommend surgery for people with severe IBD affecting the rectum and potentially more of the colon, surgery on its own is not used to manage tenesmus, says Sturrock. However, patients who have their rectum removed typically do find relief from the symptoms of tenesmus.
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