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Tenesmus: Causes, Symptoms, Treatments, and Considerations

By 19th March 2024Gut Health
Woman with Tenesmus


Tenesmus is a symptom that can be distressing as well as uncomfortable. While it’s not very common for those with IBS or SIBO it is more prevalent in conditions such as Ulcerative colitis and bowel cancer. [Source: PubMed]

The term tenesmus refers to the sensation of still requiring to go to the toilet to pass a stool (to poo), even if the bowel is fully empty.

This can lead to ongoing discomfort and pressing in the bowel. It can also lead the patient to return to the toilet to try and pass a stool. This is with the hope of eliminating more stool to provide relief. [Source: PubMed]

What Causes Tenesmus?

The actual cause of tenesmus can be due to inflammation or irritation of the nerves in the bowel wall. This can be where the nerves in that section of the bowel are highly sensitive leading to the sensation of stool needing to be eliminated.

There can be an underlying condition that leads to inflammation or irritation.

These underlying conditions include:

  • Bowel cancer
  • Inflammatory bowel diseases (Ulcerative colitis, Crohn’s disease)
  • Infectious colitis
  • Constipation or dysregulated bowel motility [Source: Mount Sinai]

While these conditions can be treated directly, for some with bowel cancer or inflammatory bowel conditions, treatment is not possible or there has been a poor response to the medical treatment that has been provided.

This means that symptom management strategies can be introduced in an attempt to manage symptoms and improve quality of life. [Source: PubMed]

How Can You Get Rid of Tenesmus?

As mentioned, the aim is to address the underlying cause of tenesmus to resolve symptoms. This can be to address issues such as cancer or Ulcerative colitis.

Understanding if there is an underlying cause of symptoms may alter the approach that is needed. However, there are natural approaches that can be considered to support the gut to help eliminate tenesmus.

When taking into consideration a common cause of tenesmus is the inflammatory bowel disease Ulcerative colitis, several well-validated approaches can be considered.

These approaches include:

  • An IBD diet, for example, the IBD-AID or low-residue diet [Source: PubMed]
  • Probiotics [Source: PubMed]
  • Anti-inflammatory herbs (e.g., curcumin) [Source: PubMed]
  • Omega 3 fish oils [Source: PubMed]

Can Stress Cause Tenesmus?

Stress and anxiety have not been short to directly cause tenesmus. However, it is known that high levels of stress or anxiety can impact digestive health.

This means that even though stress may not cause tenesmus, it may worsen Ulcerative colitis via increasing inflammation in the bowel. 

For many, this can create a cycle where the stress increases symptoms but then the increase in symptoms may in turn increase stress. [Source: PubMed]

It’s also possible for stress to lead to alterations in bowel motility and constipation. For some this may increase the irritation or inflammation in the bowel, leading to increased symptoms of tenesmus. [Source: PubMed]

Considerations for managing stress include:

  • Adaptogenic herbs such as ashwagandha [Source: PubMed]
  • Magnesium [Source: PubMed]
  • Lemon balm [Source: PubMed]
  • Meditation [Source: PubMed]
  • Time in nature [Source: PubMed]
  • Counselling or therapy [Source: PubMed]

Does Ulcerative Colitis Cause Tenesmus?

Tenesmus is among the most common symptoms people with Ulcerative colitis experience. When assessed, 63% of ulcerative colitis patients experience this symptom. [Source: PubMed]

This can be due to irritation or inflammation in the bowel wall as well as possible alterations in muscle function towards the end of the large intestine. [Source: PubMed]

Is It Normal to Have Tenesmus?

Tenesmus is not considered a normal digestive health symptom. While from time to time it can be normal to have to return to the toilet after passing a stool, the ongoing presence of tenesmus indicates an underlying issue.

While it’s not a dangerous symptom to have as such, the possible underlying causes may be more serious.

If it is present with any of the following symptoms, a doctor’s assessment may be suggested:

  • Unintentional weight loss
  • Rectal bleeding
  • Family history of bowel/ovarian cancer 
  • Anaemia
  • Abdominal/rectal mass
  • Inflammatory markers in stool tests [Source: NHS]

Is Tenesmus a Red Flag Symptom?

By itself, tenesmus is not considered a red flag symptom.

However, if other symptoms are present, this may require further investigation.

These include sudden changes in bowel patterns, unexplained weight loss and rectal bleeding. [Source: NHS]

Do Haemorrhoids Cause Tenesmus?

Haemorrhoids occur towards the end of the digestive tract. These can be uncomfortable and lead to irritation as well as blood appearing in the stool.

Due to the inflammation and irritation, this part of the gut can become more sensitive. This can present as the sensation of stool in the rectum which is the pain symptom of tenesmus. [Source: PubMed]

If haemorrhoids are present these can be addressed in several ways including:

  • Stool softeners
  • Creams [Source: NHS]
  • Banding [Source: NHS]

Can Tenesmus be Caused by Food?

Certain foods can increase symptoms of tenesmus. This may be due to the diet containing too much or too little fibre. This can be due to imbalances in the gut leading to a certain sensitivity to fibre.

However, this is not a one-size-fits-all approach and working with a practitioner can be required to help determine the appropriate level of fibre. [Source: PubMed]

In regards, to inflammatory bowel diseases such as Ulcerative colitis, immunological reactions to foods can increase symptoms.

While these foods may not trigger symptoms immediately, ongoing intake of these foods may contribute to an immune reaction that increases inflammation and the associated symptoms in the bowel. [Source: PubMed]

Constipation and Tenesmus

Often constipation is not an issue for those with tenesmus. While it may feel as though there is stool remaining in the bowel, commonly this is due to irritation or inflammation rather than stool remaining in the rectum. 

It may be the case that long-term bowel motility issues such as constipation can lead to imbalances in the large intestine. These imbalances may then lead to an increased risk of developing inflammation or irritation and subsequent tenesmus. [Source: PubMed]


While tenesmus is an irritating or disruptive symptom, understanding the underlying cause can improve clinical outcomes. 

An important part of this process can be to work with a registered gut health practitioner to support and guide.