Painful stools

Alternative names
Pain - passing stool; Tenesmus; Difficulty passing stool

Tenesmus is the constant feeling of the need to empty the bowel, accompanied by pain, cramping, and involuntary straining efforts.

Tenesmus is generally associated with inflammatory diseases of the bowel, which may be caused by either infectious or noninfectious conditions. Tenesmus is characterized by a sensation of needing to pass stool, accompanied by pain, cramping, and straining. Despite straining, little stool is passed.

Common Causes

  • Inflammatory bowel disease (IBD)  
  • Crohn’s disease  
  • Ulcerative colitis  
  • Anorectal abscess  
  • Infectious colitis (infection of the colon)  
  • Colorectal cancer or tumors  
  • Radiation proctitis or colitis (inflammation of the colon or rectum from radiation)

Home Care

If you feel that you are constipated, try to increase your fluid and fiber intake.

Call your health care provider if

Tenesmus continues, whether it is constant or intermittent. Contact your doctor if there is abdominal pain, fever, chills, blood in the stool, nausea, or vomiting. It may be a sign of an underlying disorder.

What to expect at your health care provider’s office
The medical history will be obtained and a physical examination performed.

Medical history questions documenting tenesmus in detail may include:

  • Time pattern       o Did this develop recently?       o Is it the first time you have experienced tenesmus?       o Does the feeling come and go or is it constant?  
  • Symptom history       o Is there a constant need to empty the bowels?       o Is there abdominal pain?       o Is there cramping?       o Is there a persistent feeling of straining?       o Is there diarrhea or vomiting?       o What other symptoms are also present (such as blood in stool, fever)?  
  • Dietary history       o Have you eaten anything unusual or uncooked?       o Have you been at a picnic, gathering, or similar event recently?  
  • Other       o Any medical problems in the past?       o Have any other people in your family or social group experienced similar problems?

The physical examination may include a detailed abdominal examination. A rectal examination - and prostate check for men - is performed in most cases.

Diagnostic tests that may be performed include:

  • Laboratory tests: CBC (blood count), electrolytes, and stool cultures  
  • X-rays of the abdomen  
  • A CT scan of the abdomen may be done in rare instances  
  • Colonoscopy to look at the colon and rectum

After seeing your health care provider:
You may want to add a diagnosis related to tenesmus to your personal medical record.

Johns Hopkins patient information

Last revised: December 3, 2012
by Gevorg A. Poghosian, Ph.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.