Tenesmus is difficult to ignore, and running to the bathroom repeatedly “affects quality of life significantly,” says Adam Ehrlich, MD, MPH, an assistant 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 disturbing condition and how you can treat it. RELATED: What Is Abdominal Pain? “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.
Inflammation Causes Tenesmus
Anything that causes rectal inflammation can lead to tenesmus. For example, some sexually transmitted diseases, such as chlamydia, can cause the rectum to become inflamed, says Ehrlich. Men who have received radiation therapy to the rectal area for prostate cancer may also experience tenesmus, he says. Hemorrhoids are another cause. 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. RELATED: Crohn’s Disease Management Guide
Managing 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 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. A newer medicine called budesonide MMX is also available in a suppository foam, and can reduce rectal inflammation and is effective for patients who did find success with mesalamine, according to a review published in July 2019 in Expert Reviews of Gastroenterology and 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 Remicade (infliximab). While 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. Additional reporting by Jordan Davidson.
