Health Information




Pain - passing stool; Painful stools; Difficulty passing stool

Tenesmus is the feeling that you need to pass stools, even though your bowels are already empty. It may involve straining, pain, and cramping.

I Would Like to Learn About:

  • Considerations

    Tenesmus usually occurs with inflammatory diseases of the bowels. These diseases may be caused by an infection or other conditions.

    It can also occur with diseases that affect the normal movements of the intestines. Such diseases are called motility disorders.

    Persons with tenesmus may push very hard (strain) to try to empty their bowels, but they pass little stool.

  • Causes

    • Anorectal abscess
    • Colorectal cancer or tumors
    • Crohn's disease
    • Infection of the colon (infectious colitis)
    • Inflammation of the colon or rectum from radiation (radiation proctitis or colitis)
    • Inflammatory bowel disease (IBD)
    • Movement (motility) disorder of the intestines
    • Ulcerative colitis
  • Home Care

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

  • When to Contact a Medical Professional

    Contact your health care provider if you continue to have symptoms of tenesmus that are constant or come and go.

    Also call if you have:

    • Abdominal pain
    • Blood in the stool
    • Chills
    • Fever
    • Nausea
    • Vomiting

    These symptoms could be a sign of a disease that might be causing the problem.

  • What to Expect at Your Office Visit

    The doctor will examine you and ask questions such as:

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

    The physical examination may include a detailed abdominal examination. A rectal examination is performed in most cases.

    Tests that may be done include:

    • Colonoscopy to look at the colon and rectum
    • Complete blood count (CBC)
    • CT scan of the abdomen (in rare cases)
    • Proctosigmoidoscopy (an examination of the lower bowel)
    • Stool cultures
    • X-rays of the abdomen

Related Information



Camilleri M. Disorders of gastrointestinal motility. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 138.

Cook IJ, Brookes SJ, Dinning PG. Colonic motor and sensory function and dysfunction. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 98.

Lichtenstein GP. Inflammatory bowel disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 143.


Review Date: 9/2/2012  

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

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