Tenesmus

CLINICAL DIAGNOSTIC MANUAL

Tenesmus is the constant and often ineffective urge to defecate, typically accompanied by a sensation of incomplete rectal evacuation.

This sensation can be extremely uncomfortable and frustrating for patients, as they feel an urgent need to defecate, but with little or no stool passage.

Tenesmus can be a symptom of various underlying conditions affecting the lower gastrointestinal tract, particularly the rectum and descending colon.

Condition	Symptoms and Clinical Signs	Suspected Diagnosis	Confirmatory Diagnosis
Rectal inflammation (proctitis)	Rectal pain, rectal bleeding, mucous discharge, pressure sensation in the rectum, bloody diarrhoea	Medical history and physical examination	Anoscopy, sigmoidoscopy with biopsy
Rectal tumour	Rectal bleeding, changes in bowel habits, abdominal pain, weight loss, sensation of rectal mass	Medical history, physical examination	Colonoscopy with biopsy
Descending colon tumour	Blood in stool, persistent changes in bowel habits, abdominal pain, weight loss, bowel obstruction	Medical history, physical examination	Colonoscopy with biopsy
Pelvic inflammatory disease (PID)	Lower abdominal pain, fever, abnormal vaginal discharge, dyspareunia (pain during intercourse), pain during urination	Medical history, physical examination, lab tests	Pelvic ultrasound, CT or MRI, vaginal discharge cultures
Ulcerative colitis	Bloody diarrhoea with mucus, abdominal pain, urgency to defecate	Medical history, physical examination	Colonoscopy with biopsy
Crohn’s disease	Chronic diarrhoea, abdominal pain, weight loss, occasionally rectal bleeding	Medical history, physical examination	Colonoscopy with biopsy, CT or MRI
Diverticulitis	Abdominal pain, fever, rectal bleeding	Medical history and physical examination	Abdominal CT scan, colonoscopy
Thrombosed haemorrhoids	Severe rectal pain, painful anal mass, bright red bleeding	Medical history and physical examination	Anoscopy, detailed physical examination
Rectal infections	Rectal pain, purulent or mucous discharge, bleeding, itching	Medical history, physical examination	Discharge culture, STD testing (e.g., PCR, serology)
Previous pelvic radiation therapy	Rectal pain, bleeding, changes in bowel habits	Medical history (history of radiation therapy)	Colonoscopy, biopsy