Tenesmus is a painful urge to defecate, which is usually ineffective, sometimes may be accompanied by the discharge of a small amount of feces, bloody or mucous discharge. Painful contractions of the rectal muscles most often indicate a pathology of the digestive tract or genitourinary system. In order to identify the causes of tenesmus, a physical examination, radiological methods, endoscopy, ultrasound, and laboratory tests are used. To reduce discomfort, antispasmodics, microclysters with medicinal and herbal remedies are used.
general characteristics
Tenesmus is a subjective discomfort that is described by patients as a sudden painful urge to defecate, not accompanied by the release of feces. Sometimes there is a discharge from the rectum of a small amount of mucus, blood or pus. The pain syndrome usually increases within a few minutes and almost completely subsides after going to the toilet. Pain is localized in the region of the anus, sacrum, perineum, but can also radiate to the overlying parts of the abdomen.
False desires do not have a physiological basis and always indicate the presence of a pathological lesion of the organs of the abdominal or pelvic cavity. Typically, tenesmus is combined with other dyspeptic disorders: changes in the frequency and consistency of stools, persistent abdominal pain, flatulence, nausea, and vomiting. Bleeding or purulent discharge after painful contractions of the rectal muscles indicates a serious illness and requires a mandatory visit to a doctor.
Causes of tenesmus
The appearance of painful spastic contractions of the smooth rectal muscles and muscles of the perineum, accompanied by an imperative urge to defecate, often develops with various acute and chronic inflammatory diseases of the gastrointestinal tract, urogenital pathology. Tenesmus can occur with dorsal tabes as one of the manifestations of the tabetic visceral crisis. Unpleasant sensations in the anus are sometimes associated with partial infringement of the hernia.
Diseases of the rectum
Soreness, burning and urge when the anal zone is affected are associated with an increase in the sensitivity of the rectal membranes to irritants. In such a situation, the ingestion of even a small amount of feces or mucus causes sharp spastic muscle contractions. Violation of the coordinated contraction of the sphincters of the anus leads to a delay in the contents and the appearance of severe pain. Among the causes of tenesmus are:
- Proctitis . Inflammatory damage to the rectum occurs with pronounced dyspeptic symptoms, the main of which are false urges, discomfort and itching in the anal area. Pain is associated with constant irritation of the mucous layer, exposure to pro-inflammatory mediators. Proctitis is characterized by the release of a small amount of mucopurulent rectal contents.
- Prolapse of the rectum . Tenesmus, which develop due to the displacement of the intestine beyond the external anal muscle sphincter, is provoked by mechanical irritation of the mucosa and compression of the intramural ganglia in the thickness of the rectal wall. In this condition, there is a sharp pain in the anus and perineum, a feeling of incomplete emptying after defecation, a sensation of a foreign body.
- Anal polyp . The urge to defecate occurs only with an impressive size of a benign neoplasm. Tenesmus is caused by constant pressure and irritation of nerve receptors on the surface of the rectal mucosa. Painful sensations are sometimes accompanied by the release of a few drops of blood during bowel movements, alternating constipation and diarrhea. With a long course of the disease, signs of anemia join.
- Anal fissure . Rupture of the mucous membrane of the lower rectal sections is manifested by severe pain that occurs during defecation, and can also be accompanied by tenesmus. False urges are due to the presence of an organic defect in the intestinal wall and a change in the mechanisms of reflex regulation of the act of defecation. With a neglected variant of anal fissure, patients are worried about constant severe pain radiating to the perineum.
Acute intestinal infections
The development of painful sensations preceding the act of defecation is characteristic of all microbial or parasitic invasions that occur with the involvement of the intestinal mucosa in the process. Pain appears due to the impact of microbes on the intramural autonomic nerve plexuses, which regulate the intensity and sequence of contraction of the smooth muscles of the colon, sigmoid, and rectum. The occurrence of tenesmus is often associated with intestinal infections such as:
- Dysentery . The disease proceeds with damage to the entire large intestine, the formation of ulcers and erosions of the mucosa. Dyspeptic syndrome is the leading one in the clinical picture, excruciating tenesmus is detected against the background of diffuse pain in the abdomen, nausea and vomiting. Stools with dysentery quickly lose their fecal character, a small amount of mucus, blood with impurities of pus is released from the anus.
- Salmonellosis . Tenesmus is an important sign of the gastroenterocolitic variant of the disease, in which all parts of the digestive tract are affected. Patients also experience diffuse pain and abdominal cramps, nausea, and repeated vomiting. During defecation, a small amount of stool with mucus inclusions and blood streaks is often released.
- Intestinal form of plague . This form of plague has a severe course, accompanied by a significant deterioration in the general condition and severe symptoms of intoxication. Patients complain of sharp unbearable pain along the intestines, high fever. Spasmodic contractions of the rectal muscles cause intense tenesmus. Other dyspeptic disorders are also characteristic: nausea, vomiting, diarrhea.
- Protozoal Infections . With a predominant lesion of the colon and the occurrence of tenesmus, two diseases occur - amoebiasis and balantidiasis. In amoebiasis, after painful urges, scanty stools are observed in the form of a mucous mass with blood inclusions (“raspberry jelly”). With balantidiasis, painful urges are combined with scanty stools, consisting of feces, mucus and blood.
- parasitic infestations . Severe colitis with abdominal pain, painful contractions of the rectal muscles, and other dyspeptic symptoms may indicate abdominal myiasis. This disease develops when fly larvae are swallowed. Gastrointestinal disorders are common symptoms of the chronic form of schistosomiasis. Tenesmus is often combined with constipation, pain, decreased appetite.
Chronic bowel disease
Long-term inflammatory and destructive processes in the intestines inevitably lead to the appearance of unproductive painful urges to pass feces. Tenesmus develops as a result of violations of the nervous regulation, which normally implements its effects through the autonomic ganglia. The condition is aggravated by the destruction of the intestinal mucosa, the appearance of pathological discharge, leading to constant irritation of the rectum. With complaints of tenesmus flow:
- Diabetic enteropathy . Dyspeptic symptoms in patients with diabetes mellitus are associated with polyneuropathy, in which there is damage to the autonomic nerve plexuses of the intestinal wall. Tenesmus is more likely to bother at night, patients note an increase in stools and a change in the consistency of feces. In severe cases, painful urges may develop in combination with intestinal pseudo-obstruction.
- Crohn's disease . Painful contractions of the rectal muscles and sphincters of the anus are more often observed with an advanced form of the disease. At this stage, patients develop anal fissures and rectal fistulas, through which blood and mucus are released. Tenesmus is usually combined with paroxysmal pain in the right iliac region, nausea, vomiting, severe weight loss.
- Nonspecific ulcerative colitis . Tenesmus, as a rule, occurs with ulcerative-destructive lesions of the distal large intestine. Painful urges are associated with the presence of deep mucosal defects, impaired innervation and coordinated work of muscle sphincters. Ulcerative colitis is manifested by a sharp paroxysmal abdominal pain, poor bowel movements, bleeding from the anus.
- Chronic colitis . Pathological urge to pass stool is potentiated by the influence of three factors: bacterial damage to the colonic wall, impaired local immunity, and discoordination of muscle contractions in different parts of the intestine. The most pronounced unpleasant symptoms are with sigmoiditis and left-sided colitis. Tenesmus is associated with cramping pains in the lower abdomen, scanty stools with blood impurities.
- Radiation sickness . Radiation lesions of the intestine develop with simultaneous exposure to high doses of radiation, manifested by dyspeptic symptoms: vomiting, severe abdominal pain, diarrhea. In severe situations, with the death of cells in the intestinal wall, painful tenesmus is noted without excretion of feces, which are often accompanied by rectal bleeding.
Volumetric neoplasms of the intestine
The development of painful contractions of the intestinal muscles and false urge to go to the toilet in tumor formations is associated with two main reasons: mechanical obstacles to the movement of feces and the germination of tumor tissue in the nerve plexuses of the intestine. With benign neoplasms, the general condition of patients suffers slightly, with malignant tumors, a large complex of extraintestinal pathological symptoms is observed. The most common types of formations in the gastrointestinal tract, in the clinic of which tenesmus is observed, are:
- Anorectal melanoma . The initial sign of the disease is the appearance of bright red blood on the surface of the feces during bowel movements. With the progression of education, other signs are noted: pain in the anus, sensation of a foreign body in the rectum. The cause of painful contractions of the rectal muscles is the constant irritation of the mucosa and a mechanical obstruction in the promotion of feces.
- Colonic adenocarcinoma . Initially, the tumor has no specific signs and is manifested by dull pain in the abdominal cavity, periodic dyspeptic disorders. With an increase in education, tenesmus is observed associated with partial blockage of the lumen of the colon. Patients are concerned about passing small amounts of dark blood in the stool. In severe cases, bleeding from the gastrointestinal tract occurs.
- Intestinal polyps . These neoplasms are benign, unpleasant symptoms are mainly due to the existence of a mechanical obstacle to the movement of feces and partial intestinal obstruction. Dyskinesia of different parts of the colon is found, accompanied by false urge to go to the toilet. Colon pseudopolyposis has a similar clinical picture.
Urogenital pathology
The appearance of unpleasant symptoms from the digestive system with lesions of the genitourinary tract is due to the proximity of the location of these organs, common innervation and the presence of pathological viscero-visceral reflexes. Painful sensations are often poorly localized, patients describe them as diffuse pain in the pelvic area. Most often, the following urogenital diseases lead to the appearance of painful tenesmus:
- Acute prostatitis . With purulent inflammation of the prostate gland, there are sharp pains in the pelvic cavity, which radiate to the sacrococcygeal zone, the rectum. Severe pain syndrome causes a pathological spasm of the anal sphincters, which leads to the impossibility of defecation and tenesmus. The disease is always accompanied by dysuric disorders.
- Genital trauma . When the perineal region is damaged, associated injuries often occur with the involvement of nearby anatomical structures. Hematomas, ruptures of the mucous membrane lead to increased irritability of the rectal walls, sharp pains and retention of feces, which is accompanied by false painful urge to defecate.
- Renal colic . The first sign of the disease is a sharp cramping pain in the lumbar region, which can radiate to the leg, perineum or anorectal region. The development of tenesmus is due to a reflex spasm of the entire smooth muscles of the intestine in response to a strong pain stimulus during an attack of renal colic. The condition is accompanied by anuria, vomiting, tachycardia.
- Diseases of the uterus . Painful contractions of the muscles of the rectum often occur with uterine-intestinal fistulas, through which purulent contents enter the rectum and have an irritating effect. Tenesmus and chronic constipation are sometimes a symptom of malignant tumors of the uterus that are located close to the intestinal wall or germinate into it.
Purulent inflammation
For abscesses of the abdominal cavity and pelvis, general manifestations are more characteristic: hectic fever, nausea, tachycardia. Against the background of general intoxication, intense pain occurs in the abdomen, which intensifies with a change in body position. False urges to defecate develop secondarily as a result of reflex irritation of the walls of the rectum and sigmoid colon. With abscesses of the Douglas pouch, tenesmus may be combined with stool and intestinal gas.
Survey
Diagnostic measures are aimed at studying the functional and morphological state of the digestive tract to clarify the cause of false urge to defecate. The examination usually includes laboratory and instrumental methods, helps to identify diseases of the gastrointestinal tract at an early stage. The most valuable for making a clinical diagnosis in patients with tenesmus are:
- X-ray examination . For a detailed study of the structure of all parts of the intestine, radiography of the passage of barium through the small and large intestines is used. Clearer images of the internal state of the colonic wall can be obtained by irrigography with double contrast.
- Examination of the rectum . Quite informative and accessible methods include digital examination of the internal surface of the organ and anoscopy, which are performed to clarify the proctological pathology, often leading to the development of tenesmus.
- Endoscopy . Colonoscopy is the main and most diagnostically valuable study, during which it is possible to assess in detail the condition of the mucous layer of all parts of the large intestine, visualize signs of inflammatory lesions and tumor formations. According to indications during the examination, a biopsy of individual areas is taken.
- Ultrasound . Abdominal ultrasonography is a non-invasive method often used as a screening tool to identify patients with gastroenterological pathology. Plain sonography of the abdominal cavity helps to detect signs of inflammation, volumetric neoplasms, against which tenesmus is noted.
- Coprogram . In diseases that are symptomatic of tenesmus, changes in fecal analyzes are often determined. All patients are prescribed a standard study of feces, if an infectious etiology of the disease is suspected, an extended bacteriological culture is performed, and feces are analyzed for helminth eggs.
To clarify the diagnosis, computed tomography, anorectal manometry, laboratory blood tests for specific antibodies can be performed. A patient with tenesmus is examined by a gastroenterologist or proctologist. After exclusion of diseases of the digestive tract, additional studies of the genitourinary organs may be prescribed to identify the causes of the disorder.
Colonoscopy
Symptomatic therapy
Intestinal tenesmus has no physiological causes and indicates damage to the gastrointestinal tract or genitourinary system. Therefore, the patient should seek medical help for an examination and the appointment of complex therapy. To reduce spasm of the muscular layer of the intestine, no-shpa and other antispasmodics can be used. For temporary relief of the patient's condition, rectal suppositories, microclysters with anesthetics, baths with herbal decoctions are used.