I feel like I have to poop but only a little comes out

Can You Be Constipated and Still Poop?

The causes list for incomplete evacuation is very long. From diet to medicines to lifestyle, there are many factors.

Common causes

  • Diet. Not drinking enough water or eating enough fiber are common constipation contributors. Replacing these foods with dairy products and sugary foods can further the problem. Switching to a diet higher in fiber and fluids can help reduce constipation symptoms in many people.
  • Ignoring the urge to go. If you resist the urge to go too often, it messes with your nerves that sense when it’s time to poop. Over time, this can lead to constipation.
  • Irritable bowel syndrome (IBS). This condition can cause chronic constipation as well as stomach pain and bloating.
  • Medications. Many medications can slow down intestinal movement or affect how the nerves and muscles in the digestive tract work. While you shouldn’t stop taking any medicines without your doctor’s approval, medications that treat conditions like depression, diabetes, high blood pressure, and Parkinson’s disease can cause constipation.
  • Sedentary lifestyle. Movement and exercise can help stimulate the bowels to move stool forward. People who are confined to bed or get very little physical activity are more prone to incomplete evacuation.
  • Dyssynergic defecation. This condition occurs when the nerves and muscles responsible for promoting defecation don’t work together as they should. Examples include if the anal muscles don’t relax enough for stool to leave the body, or if the rectal muscles tighten instead of relaxing.

Less common causes

  • Anal fissure. An anal fissure occurs when there’s a tear near the end of the anus. This causes often-extreme pain when trying to pass stool.
  • Cancer. Cancers of the bowel and anus can cause constipation. Other symptoms may include rectal bleeding, chronic stomach discomfort, and unexplained fatigue.
  • Hypothyroidism. A low-performing thyroid affects the hormones that promote digestion, which can result in constipation.
  • Neurological disorders. Disorders such as Parkinson’s disease or a history of brain injuries can lead to nervous system dysfunction that causes constipation.
  • Stricture. A stricture occurs when a part of the intestines becomes narrower. Stool is harder to pass through this narrow place.
  • Anxiety and depression. A strong connection exists between the body and mind. Those who are anxious or depressed are more likely to experience incomplete evacuation. Taking medicines for anxiety and depression, unfortunately, can also contribute to constipation.

A healthcare provider can help you determine if a current condition, or a medication you’re taking is causing your constipation.

Tenesmus: The Troubling Symptom You Can’t Ignore

“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 on time. When they get there, “not much of anything comes out, and is sometimes uncomfortable.” People may also experience mucous discharge from the anus.

RELATED: How Proactive Are You About Your IBD Care?

The Culprit? Inflammation

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.

In a small study of 38 patients with IBD published in July 2016 in the National Journal of Medical Research, more than 90 percent of individuals with ulcerative colitis reported tenesmus, while about 18 percent of those with Crohn’s had the symptom.

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, according to a study published in April 2015 in Gastroenterology.

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 symptom.

Neurology

Bladder dysfunction and bowel dysfunction refer to problems with urinating and passing stools. These may lead to the unwanted passage of urine or stool, called urinary or fecal incontinence.

If you have these types of bladder and bowel problems, you may feel embarrassed at the thought of bringing them up with your doctor or other health care provider. The conditions can be physically and emotionally difficult to deal with, but you shouldn’t feel uncomfortable about talking to your health care provider. Health care providers are used to dealing with these issues and can help you manage the problem.

Causes of bladder and bowel dysfunction

For the bladder and bowel to function correctly, certain nerves in your body need to control the right muscles, telling them when to contract and when to release in order to allow urine and feces to be eliminated when you want them to.

This happens when the nerves in the spinal cord send messages from the brain to the bladder and sphincter muscles to control the flow of urine. The muscles within the rectum and anus help control your bowels, and sphincter muscles control or release stool.

Urinary problems

A number of conditions may affect the nerves and muscles that control the bladder and bowel, resulting in dysfunction and possible incontinence.

For the bladder, these conditions include:

  • Overactive bladder. As the name suggests, you may have to go much more frequently than you would like. This can include an urgent need to urinate or having to urinate up to eight times or more a day and twice at night.

  • Difficulty controlling sphincter muscles. If the nerves to these muscles have been damaged, they may not cooperate when you want to tighten or release them to pass urine.

  • Holding urine in too long (urine retention). Sometimes nerve damage means that the bladder muscles don’t get the chemical message that it’s time for you to go. If the urine stays in the bladder too long, pressure may build up and lead to infection or damage of the bladder or kidneys.

Bowel problems

Fecal incontinence means you may not make it to the bathroom when you have a bowel movement, or you may “leak” a little when you pass gas.

Conditions that raise the risk for fecal incontinence include:

  • Diarrhea

  • Constipation

  • Damage to the nervous system from disease or injury

  • Poor health

  • Vaginal childbirth

  • Rectal prolapse (when the rectum protrudes into the anus)

  • Rectocele (when the rectum pushes into the vagina)

Other conditions

These are other health issues that may contribute to bladder and/or bowel dysfunction:

  • Medication side effects

  • Stress

  • Multiple sclerosis

  • Stroke

  • Alzheimer’s disease

  • Diabetes

  • Infections, including spinal cord or brain infections

  • Hemorrhoids

  • Problems with the pelvic floor

  • Digestive problems, such as constipation or diarrhea

  • Abnormalities that affect the urinary or digestive tract

  • Problems affecting the nerves that control the urinary or digestive tract

You could also have metal poisoning, congenital nerve-related problems, or injury or damage to the rectum caused by surgery or by conditions, such as Crohn’s disease or ulcerative colitis.

Managing bladder and bowel dysfunction

Depending on the nature of your problem and your symptoms, your health care provider will work with you to create a plan of action. Here are some common treatments:

  • Changing your diet. Gradually increasing your fiber intake can help manage the diarrhea and constipation that can lead to fecal incontinence. Drinking plenty of fluids can also ease constipation, and restricting fluids at times can help manage overactive bladder or urinary incontinence.

  • Exercises. Kegel exercises can strengthen the sphincter muscles and pelvic floor. This can provide better control and ease bladder and bowel dysfunction. Ask your doctor whether they might help in your case and, if so, how to do them.

  • Medications. Some medications, including fiber supplements, can help control bowel dysfunction, and antidiarrheal medications can help manage diarrhea. Prescription medications are also available to help bladder muscles relax to promote better bladder control.

  • Training. Programs that “train” the bowels and bladder can give you better control and manage dysfunction. This includes setting a regular schedule for using the toilet and attempting to urinate or have bowel movements at the same time each day.

  • Electrical stimulation. This therapy can stimulate damaged nerves and promote better muscle control and control over urine and feces.

  • Surgery. In rare cases, you may need surgery to repair damage to the muscles or nerves that are causing bladder or bowel dysfunction.

You don’t have to suffer in silence. Finding the right therapy and management techniques can help you overcome bladder or bowel problems and avoid embarrassing incidents.

Why Do I Have Tenesmus?

If you’re experiencing tenesmus, there are a number of treatment options available. In most cases, it can be relieved using home remedies.

Treatment at home

If an IBD or motility disorder is causing your symptoms, you can help relieve your cramps and discomfort by making some diet and lifestyle changes. These home treatment options also double as great tenesmus prevention methods.

High-fiber diet

Eating a diet that’s high in fiber is one of the best ways to relieve your tenesmus. Consuming at least 20 grams of fiber every day will make your stool softer and add weight to it. This helps your body pass the stool more easily.

If you have ulcers or scarring in your GI tract, you should be able to pass a softer stool more easily and with less pain.

Drink water

Drinking enough water is important in making sure your stool is soft as well.

Physical activity

Physical activity stimulates movement in your intestines. Exercising regularly can help your tenesmus by helping your intestines move waste through your GI tract.

Medical treatment

Medical treatment will vary depending on the cause of your tenesmus.

IBD

Medical treatment of IBD is aimed at stopping the inflammation that causes your symptoms. The following medications might be prescribed:

  • Anti-inflammatory drugs that reduce your inflammation are usually the first step in treatment.
  • Medications that lower your immune system might also be used when treating IBD.
  • Antibiotics might be prescribed to help kill bacteria in your intestines that could be causing your IBD and tenesmus.

Motility disorders

If diarrhea has caused your tenesmus, your doctor might treat your condition with antibiotics, which are effective in fighting bacteria and parasites. If a virus is the cause of your diarrhea, antibiotics won’t be effective.

Your doctor might take you off certain medications if they cause your diarrhea.

If constipation led to your tenesmus, laxatives and medications that help add water to your stool might be an option for you.

In more severe cases, your doctor might break up the compacted stool manually. They’ll do this by using their finger.

Everything you need to know about tenesmus

Treatment depends on the severity of the tenesmus and its underlying cause.

Inflammatory bowel disease

Treatment for IBD aims to relieve discomfort, achieve and maintain remission of symptoms, and prevent complications. Medications and surgery are the most common options.

Drugs for relieving the symptoms of IBD, including tenesmus, include:

Anti-inflammatory drugs: Oral or rectal medications can reduce inflammation and help achieve or maintain remission.

Immune system suppressors: These can inhibit the immune system response that causes inflammation.

Corticosteroid therapy: Fast acting systemic steroids can help manage IBD flares by reducing inflammation.

TNF blockers: Another type of immunosuppressant, such as a monoclonal antibody, can target substances in the body that lead to inflammation.

Antibiotics: These can help defeat bacteria that may be causing symptoms or making them worse.

Laxatives: These can help if tenesmus results from constipation.

Pain relief: A person can take pain relief medication alongside other therapies.

In some cases, a doctor may recommend surgery to relieve symptoms after medications failed to do so.

Learn more here about surgery for ulcerative colitis, a type of IBD.

Any condition that causes the movement of food or waste through the digestive tract to speed up or slow down is an intestinal motility disorder. A person with a motility disorder may have diarrhea or constipation.

Diarrhea: If tenesmus results from infectious diarrhea, a doctor may prescribe antibiotics or anti-parasitics, depending on the underlying cause.

If diarrhea results from certain foods or medications, they may recommend avoiding the trigger item. Examples of ingredients that can trigger diarrhea in some people include lactose, sucrose, and caffeine.

Antidiarrheal agents, such asLoperamide (Imodium), can help relieve symptoms.

Laxatives: If tenesmus results from constipation, a laxative may help the stool pass through the colon more easily.

If constipation causes stool to become impacted, a blockage may result. The doctor may remove the stool manually or flush it out with a rectal laxative enema or water irrigation.

Dietary changes can help with both constipation and diarrhea.

Get some tips on treating constipation at home.

Find out how to treat diarrhea at home.

Colorectal cancer

Tenesmus can be a sign of a blockage due to a cancerous tumor.

The doctor may recommend a combination of surgery, chemotherapy, and radiation therapy, depending on the stage of the cancer and the person’s overall health. Removing the tumor will often relieve tenesmus.

Sometimes, after surgery, waste will not be able to pass through the large intestine. When this occurs, a person will need to have a colostomy. Find out more about what this involves here.

It is not always possible to cure colorectal cancer. Palliative care can help a person feel more comfortable while living with cancer.

Options for improving a person’s comfort and quality of life with cancer-related tenesmus include:

  • drug therapies
  • treatment to relieve pain
  • endoscopic laser interventions

These will not cure cancer, but they can help relieve symptoms.

Other causes

Tenesmus that results from a sexually transmitted infection should resolve when the person receives treatment for the infection.

Bowel cancer: The 5 warning signs you shouldn’t ignore

Looking into the toilet bowl after you’ve been is not the most pleasant of experiences, but knowledge of your poo habits might just save your life.

Bowel cancer is currently the UK’s second deadliest cancer, with someone dying of the disease every half an hour. But if it’s caught early it is treatable.

“We know that nine out of 10 cases of bowel cancer can be treated successfully if diagnosed early”, says Mark Flannagan, chief executive of UK charity Beating Bowel Cancer.
Paramount to this early diagnosis is that people are aware of what’s going on with their poo, and that any persistent changes in the normal routine and any signs of blood are checked out immediately.

Hollyoaks actor Ben Richards rdismissed his bowel cancer symptoms as a reaction to spicy food he ate while on holiday in India.

He told The Daily Mirror: “Being a typical bloke, I self-diagnosed. I was convinced it was due to the spicy food I’d been eating in India.

“Besides, I was pretty healthy. I was in good shape and looked after myself…”

Doctors discovered a 6cm long tumour in his bowel and underwent radiotherapy as well as taking chemotherapy tablets. He has now been clear of cancer for four years.

Here’s exactly what you need to know about poo and bowel cancer:

1. Stools with blood

Very often, blood in stools is from piles (haemorrhoids), especially if it is bright red, fresh blood – this is because piles are basically swollen veins in the back passage which can easily get damaged when you poo, causing a small amount of bleeding.
But if the blood seems darker, it could be a sign of cancer higher up in the bowel, which has time to go darker as it moves through the bowel. Your stool will be very dark, almost like tar. It could also be bleeding from an ulcer, but either way, you need to see the doctor and get it checked.

2. Looser stools

Everyone can have the odd bout of diarrhoea, from dodgy food, stress or (for women) that time of the month. But if you notice a change to your normal bowel habits that last longer than four to six weeks (though some experts say three), it needs to be checked. This is particularly the case if your stools are looser.

3. More frequent stools

Similar to above, if you notice you’re needing to go a lot more often (and haven’t really changed your diet), it could be an early sign that something’s up.

4. Straining to poo

Constipation, like diarrhoea, is something everyone might have occasionally, but like diarrhoea, if it’s ongoing, you need to aware. Sometimes the cancer tumour can block the bowel, leading to symptoms of intense pains in the abdomen, bloating, being sick, and being constipated.

5. Straining to poo but not actually ‘going’

Sometimes, feeling like you need to go, even though you don’t, can be an early symptom of bowel cancer.

Irritable bowel syndrome: what you need to know

What is irritable bowel syndrome?

Irritable bowel syndrome (IBS) is a chronic (ongoing) disorder in which the normal rhythmic movement of your gut (bowel) is disturbed — this can lead to abdominal pain, bloating and excessive gas. You may have trouble going to the toilet (constipation), or have very loose and urgent bowel motions or stools (diarrhoea).

Irritable bowel syndrome is very common — up to one in 6 Australians will have IBS symptoms at some time in their life.

How do you get irritable bowel syndrome?

No one knows exactly what causes irritable bowel syndrome, although stress can make the condition worse.

A combination of several factors is thought to be involved in the development of IBS. It may be that your system can’t handle some foods. Other factors may include:

  • the nerves in the bowel being extra sensitive;
  • having altered levels of circulating hormones and chemicals called neurotransmitters that act on the bowel; and
  • changes in the type and amount of bacteria in the small intestine.

You may have had food poisoning or another gastrointestinal infection in the past, which has affected the nerves in your gut and caused IBS symptoms to start or recur.

Irritable bowel syndrome is more commonly seen in people who have family members with gastrointestinal conditions.

What does irritable bowel syndrome feel like?

If you have irritable bowel syndrome you may experience the following symptoms:

  • cramps and bloating in your lower abdomen;
  • pain in the abdomen that may be worse on your left side and that usually feels better after you go to the toilet or pass wind;
  • mucus in your stools;
  • diarrhoea — having to go to the toilet too often or urgently and having very loose stools;
  • constipation — not going to the toilet enough, having small, hard stools that might be hard to push out; feeling that you have not finished; or
  • you may have constipation some times, diarrhoea others, and then be fine for a while.

What makes irritable bowel syndrome worse?

People with IBS find that certain things can make their symptoms worse. These so-called triggers may include the following.

  • Some food and drinks. Each person is different, but foods that may be a problem are fatty foods, sugary foods or those containing sweeteners, ones that cause gas (e.g. carbonated drinks), and milk, chocolate, coffee, tea and alcohol.
  • Eating too quickly or too much.
  • Uncontrolled stress.
  • Some women find that their IBS symptoms are worse when they have their period.

Avoid your triggers as much as possible to help control IBS symptoms.

Diagnosis

Your doctor will usually make a diagnosis of irritable bowel syndrome based on your symptoms. To help make the diagnosis your doctor will want a detailed description of your symptoms, including how often you are affected and what makes your symptoms better or worse.

If there is uncertainty about whether you have a more serious problem (e.g. if you have bleeding from the bowel, or considerable weight loss, which do not occur in IBS) your doctor may order other tests, such as:

  • blood tests;
  • a stool sample test;
  • a sigmoidoscopy (to look at the lining of the last part of your bowel using a lighted tube with a camera); or
  • a colonoscopy (to look at the lining of your large intestine through a flexible, lighted tube with a camera).

If you have IBS, the results of all these tests are likely to be normal.

Treatment: what makes irritable bowel syndrome better?

While medicines can help relieve some of the symptoms of IBS, no cure is currently available. So modifying your lifestyle is the most important thing you can do.

Lifestyle modifications for IBS

The following self-care measures can help improve your IBS symptoms.

  • Avoiding or learning how to handle stress: counselling; yoga; breathing exercises; meditation; and relaxation tapes and classes may help.
  • Exercise — being more active helps digestion.
  • Eating well, including a variety of foods and plenty of vegetables, fibre and water. Add fibre to your diet slowly as it may make things worse at first.
  • Regular, small meals are recommended.
  • Write down what you have been eating, doing and feeling when your gut gets upset, to see if there is any pattern, and try to avoid possible IBS triggers in future.

Your doctor can discuss dietary options and refer you to a dietitian for specific advice.

Medicines and therapies for IBS

If your IBS symptoms are not being controlled by the self-care measures outlined above, your doctor may recommend or prescribe medicines to help with cramping, pain, diarrhoea or constipation. Be careful to use your IBS medicines only at the times that your doctor suggests, rather than using them continuously.

In addition to medicines, eating foods and/or taking products that contain probiotics may help control some IBS symptoms. Ask your doctor for advice on taking probiotics.

There are also psychological treatments that may benefit people with IBS who have symptoms triggered by stress, anxiety and depression.

IBS should not cause blood in the stools, fever, or symptoms that wake you up at night. If you have symptoms like these, or vomiting, dizziness or fainting, you should see your doctor.

What happens if irritable bowel syndrome is not treated?

Irritable bowel syndrome can cause considerable discomfort and distress, but is not life-threatening. Many people worry about cancer, but there is no link between IBS and bowel cancer or other serious conditions. See your doctor if you are concerned.

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Last Reviewed: 14/11/2016

myDr

Rectal tenesmus

Rectal tenesmus is a medical condition characterized by a spasmodic contraction and often associated with pain in the rectum, accompanied by a continuous urge to evacuate, even when an individual’s bowels are relatively empty. When an individual has tenesmus, they may strain harder to produce even the smallest quantities of fecal material during bowel movements.

There are different reasons that may be the cause of this disorder and doctors believe that the immune system might cause inflammation of the digestive tract while fighting off an invading organism such as the presence of proctitis, colitis, anal fissures, intestinal polyps, irritable bowel syndrome, or tumors in the intestine.

Rectal tenesmus may be accompanied by other symptoms such as abdominal cramps, abdominal pain, nausea, flatulence, gurgling, itching and/or burning of the anal region. Identifying the underlying cause and treating the condition is necessary in order to prevent further complications such as ulcers, abscesses, and anemia.

What diseases may be associated with rectal tenesmus?

Rectal tenesmus can occur even when the rectum is not inflamed. In such situations, the nerves are excessively sensitive to gas and stool in the rectum and trigger signals to the brain informing it of rectal fullness.

This condition is most commonly associated with irritable bowel syndrome (IBS). During irritable bowel syndrome, the nerves in the rectum become excessively sensitive from increased constipation as well as increased gas and stool.

Other diseases that may be associated with rectal tenesmus include the following:

  • Anal cancer
  • Colon cancer
  • Colorectal cancer
  • Anxiety
  • Constipation
  • Chlamydia
  • Gonorrhea
  • Colitis
  • Ulcerative colitis
  • Proctitis
  • Intestinal polyps
  • Cervical carcinoma
  • Onicofagia
  • Amoebiasis
  • Irritable bowel syndrome
  • Ischemic colitis
  • Inflammatory bowel disease
  • Shigellosis

Keep in mind that this list is not exhaustive and it is always a good idea to consult with a doctor regarding any questions or concerns.

What are possible treatment options for rectal tenesmus?

Specific treatment therapy for rectal tenesmus is significantly linked to the exact cause of an individual’s condition (colitis, anxiety, cancer, etc). Surgery may be required in cases involving polyps or cancer. In a greater number of cases, a simple pharmacological intervention is done and the condition is treated with certain medications and lifestyle changes. Increase of fiber and fluids in an individual’s diet can help ease constipation as well. The ultimate goal of rectal tenesmus treatment is to reduce inflammation, ease pain, relieve symptoms as well as treat infection.

When is it advised to consult with a doctor regarding rectal tenesmus?

Consulting with a doctor is advised for individuals who have already received diagnosis of rectal tenesmus and need to be informed of the necessary steps required to act upon the condition or individuals who are at risk of a disease associated with the condition (see list of associated diseases). Also, if an individual experiences tenesmus, talking to a doctor about persistent symptoms (abdominal pain, blood in the stool, vomiting, chills, etc) may be necessary in order to prevent further complications and determine the most appropriate form of treatment for the patient’s situation. The earlier the condition is treated, the better chance an individual has of making a full recovery.

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