tenesmus

Tenesmus is a medical symptom characterized by a distressing, persistent urge to defecate that is not relieved by stool passage. It is often accompanied by cramping, rectal pressure or pain, a feeling of incomplete evacuation, and sometimes fecal leakage or blood. The symptom results from irritation or inflammation of the rectum or pelvic floor and is a sign rather than a diagnosis.

Common causes include inflammatory bowel disease (such as ulcerative colitis and Crohn's disease with rectal involvement), infectious proctitis or other rectal inflammation, hemorrhoids, anal fissures, rectal ulcers, rectal prolapse, and colorectal cancer. Less frequent contributors include diverticular disease, radiation proctitis, pelvic floor dyssnergia, certain medications, and postoperative changes. Tenesmus can occur with both acute conditions and chronic disorders, and its presence may reflect local rectal pathology or broader gastrointestinal or pelvic floor dysfunction.

Diagnosis begins with a detailed history and a digital rectal examination. Evaluation often includes blood tests (for anemia or inflammation), stool studies for infections or occult blood, and fecal calprotectin. Endoscopic assessment with flexible sigmoidoscopy or colonoscopy is commonly performed to visualize the rectum and colon. Imaging (such as CT or MRI) may be used if a structural lesion or cancer is suspected. In selected cases, anorectal manometry or other pelvic floor studies may help identify functional causes.

Management targets the underlying cause. Treatments may involve antibiotics or anti-inflammatory therapy for infections or inflammatory disease, topical therapies for fissures or proctitis, medications to regulate stool, and, when necessary, surgical interventions for conditions such as rectal prolapse or cancer.