"I feel like I have to poop but only a little comes out." "I can't poop, but I feel like I have to." "Why do I always feel like I have to poop?"
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If this inner monologue runs through your mind on a daily basis, you could have a bowel problem.
While it's not uncommon to have trouble going to the bathroom or get hit with a crampy, have-to-go-now feeling every once a while, constantly feeling like you have to poop and not being able to go may be a sign of a condition called tenesmus.
Tenesmus isn't just annoying and uncomfortable. It's often indicative of an underlying colorectal problem like poorly managed IBD.
Here's what you should know about the condition, plus the steps you can take to get your bathroom trips under control.
What Is Tenesmus?
Tenesmus is the name doctors use to describe the sensation of needing to pass stool when your bowels are empty. That might sound sort of like constipation — where you have to poop but the stool is too hard, firm or dry to be pushed out — but the two are actually very different.
With tenesmus, "it's the urge or feeling that you need to have a bowel movement, but there are no stool or contents to evacuate," explains Adam Faye, MD, a gastroenterologist at the Inflammatory Bowel Disease Center at NYU Langone Health. "This sensation can often be quite uncomfortable and necessitate frequent trips to the bathroom in an attempt to evacuate."
Symptoms of Tenesmus
How can you tell if your bowel problems are caused by tenesmus? The most common symptom is frequently having intense urges to poop, but when you go to try, nothing (or very little) actually comes out, says Siamik Tabib, MD, a gastroenterologist, hepatologist and assistant professor of medicine at University of California Los Angeles.
In some cases, the feeling like you need to poop could be almost constant and cause abdominal cramping and pain, per the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
In short, the signs include:
- Frequently feeling the urgent need to poop
- Often passing only a small amount of stool
- Discomfort during bowel movements
- Feeling as if you can't empty your bowels completely, or not feeling empty after a bowel movement
What Causes a Constant Urge to Poop?
Most often, tenesmus occurs alongside inflammatory bowel diseases like ulcerative colitis or Crohn's disease.
"The rectum is a reservoir to hold stool, and when it's inflamed, its ability to do so is decreased," Dr. Faye says. "This can lead to contractions of the musculature in an attempt to evacuate any content that may be present."
IBDs aren't the only possible culprit though. "Other conditions causing inflammation or irritation to the area of the rectum may also cause tenesmus," Dr. Faye says.
According to the National Institutes of Health (NIH), these can include:
- Anorectal abscess
- Colorectal cancer or tumors
- Colon infections
- Colon or rectal inflammation from radiation
- Movement or motility disorders of the intestines
If you feel like you need to poop all the time, the treatment will depend on the underlying cause.
"Since rectal inflammation often drives the sensation of tenesmus, our therapeutic goal is to heal this inflammation," Dr. Faye says.
That may involve making lifestyle adjustments, such as:
- Changing your fiber intake
- Cutting out foods that seem to trigger inflammation
- Drinking more water
- Managing stress
In some cases, medical therapies like the following may be needed:
- Oral drugs
- Infusions or injections
Once the inflammation trigger is addressed, tenesmus symptoms can start to ease up within a matter of days or weeks. However, it's important to note that because IBD is a lifelong condition, tenesmus symptoms have the potential to come and go over time, Dr. Tabib says.
Tenesmus triggered by a problem other than IBD often involves addressing the root cause. "In the instance of a cancer or tumor, removal, resection or chemotherapy may be attempted, depending on several clinical factors," Dr. Faye says.
Your gastroenterology care team will determine the best treatment for you based on your diagnosis.
When to See a Doctor
Occasionally having trouble going to the bathroom probably isn't cause for concern. But you should talk with your doctor if you're experiencing frequent or ongoing symptoms of tenesmus, especially if you often feel like you have to poop but nothing comes out.
Seek medical care, too, if your bowel symptoms are accompanied by any of the following problems, per the NIH:
- Bloody stool