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Rectal tenesmus is the sensation of incomplete evacuation of the bowels, often accompanied by a constant urge to defecate, even when the rectum is empty. This condition can cause significant discomfort and distress due to the frequent need to go to the bathroom without relief. The sensation can be described as a persistent feeling of pressure or fullness in the rectum, and it may be associated with pain or cramping. The causes of rectal tenesmus are varied and can include both inflammatory and non-inflammatory conditions. One of the most common causes is inflammatory bowel disease (IBD), such as ulcerative colitis and Crohn's disease, which leads to chronic inflammation of the intestinal lining. This inflammation can cause spasms and contractions in the rectum, leading to the sensation of incomplete bowel movements. Infections, particularly those caused by bacterial pathogens such as Salmonella, Shigella, or Clostridium difficile, can also lead to tenesmus due to irritation and inflammation of the rectal mucosa. Non-inflammatory causes include colorectal cancer, which can obstruct the bowel or irritate the lining, leading to tenesmus. Additionally, irritable bowel syndrome (IBS), a functional gastrointestinal disorder, can cause tenesmus due to abnormal bowel motility and sensitivity. Rectal or anal disorders such as hemorrhoids, rectal prolapse, or fecal impaction can also contribute to this condition by causing a sensation of incomplete evacuation or persistent rectal pressure.
Treatment for rectal tenesmus depends on addressing the underlying cause. For inflammatory conditions like IBD, treatment may include anti-inflammatory medications, immunosuppressants, or biologic therapies to reduce inflammation and control symptoms. Infections are typically managed with appropriate antibiotics or antiparasitic medications, depending on the pathogen involved. For non-inflammatory causes, such as colorectal cancer, treatment options may include surgery, chemotherapy, or radiation therapy, depending on the stage and extent of the disease. Managing IBS-related tenesmus often involves dietary modifications, stress management, and medications to regulate bowel movements and reduce discomfort. In cases of hemorrhoids or rectal prolapse, surgical or minimally invasive procedures may be required. Symptomatic relief for tenesmus can include the use of stool softeners, fiber supplements, and pain management strategies, including antispasmodics or analgesics, to reduce rectal pressure and discomfort. A comprehensive evaluation by a healthcare provider is essential to determine the appropriate treatment plan based on the specific cause of tenesmus.
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