What Is Rectal Tenesmus?

I am sure most of you have been in a bathroom stall, reading the wise sprawling of a previous occupant. 

One catchy little rhyme you may recall reading is, “here I sit all broken-hearted, went to poop but only farted,” or some other colorful version.

What is even more interesting than reading bathroom stall poetry, is that that little rhyme refers to an actual medical symptom. Say what!?

Tenesmus is the feeling that you need to pass stools, even though your bowels are already empty. 

This can consist of cramping, straining, and the passage of little to no fecal matter. What is frustrating is that you get all the feelings that you are about to have a ‘Bristol Seven' kind of situation and then you end up with nothing to show for it. 

Side Note - The Bristol Chart is a clinical tool used to measure the quality of your poop for scientific purposes including as part of IBS diagnosis. This chart “scores” your poop on a 1-7 scale where essentially the lower the number, the harder the poop. 

Though not a stand-alone diagnosis, tenesmus is a symptom of Irritable Bowel Disease (IBD) or Irritable Bowel Syndrome (IBS). You can also get this sensation with hemorrhoids, infections, and other GI motility disorders. Because of the gut and brain connection- tenesmus can also be linked to high stress and anxiety for those who suffer from IBD/IBS. 

You may be asking yourself, “How can I get this symptom under control?” 

One can best manage the principal issue, which may be your chronic IBD or IBS. Adhering to your treatment regimen may prevent rectal inflammation from becoming severe, resulting in tenesmus. Many helpful resources are available, such as this Guide to Dealing with Tenesmus from Crohn’s Colitis for people struggling with tenesmus and needing to connect to a support team. 

If we are being honest, it is natural to veer back to old habits when feeling well or having reduced symptoms over time. Maybe you have tested the limits with certain trigger foods only to now have this tenesmus symptom that is uncomfortable as well as disheartening. Another helpful tip is to maintain a food journal of trigger foods or foods you consume around tenesmus events.

Other strategies would be to also follow the dietary guidelines for your condition.

If you are following the Low FODMAP diet, consider consulting a FODMAP-trained Dietitian to help assist you if you are having challenges navigating the phases, especially the transitions from elimination to reintroduction. 

Make sure you are taking in enough fluid and fiber to maintain regular bowel movements; the fiber will help bulk stools. Remember to know your triggers and limit high-fat foods, concentrated sweets, and caffeine (I know that one is a hard one) if they are troublesome.

All joking aside, this is not a wonderful symptom to have to deal with. If you are someone who suffers from tenesmus- make sure you let your doctor know, especially if you have been following your treatment regimen. I and the other expert contributors try to keep things light-hearted because, well sometimes- laughter can help when you feel terrible. I hope to bring awareness and insight to all aspects of IBS/IBD and other GI disorders because the gut is a mysterious beast with its very own, complex ecosystem (see gut microbiome).