🔅TENESMUS

– Tenesmus is a medical term that describes the sensation of needing to pass stool or urine, even when the bowel or bladder is empty. It can cause discomfort, pain, cramping, and straining during bowel movements or urination. Tenesmus can affect the rectum (rectal tenesmus) or the bladder (vesical tenesmus), and it can have various causes, types, symptoms, and treatments.

CAUSES OF TENESMUS

– Some of the possible causes of tenesmus are:

1) Inflammatory bowel disease (IBD): This is a group of chronic conditions that cause inflammation and ulcers in the digestive tract, such as ulcerative colitis and Crohn's disease. IBD can affect any part of the GI tract, but it often involves the colon and rectum, leading to rectal tenesmus. IBD can also cause diarrhea, bleeding, weight loss, and fatigue.

2) Infections: These are caused by bacteria, viruses, fungi, or parasites that invade the bowel or bladder and cause inflammation, ulcers, or lesions.

– Some examples of infections that can cause tenesmus are:

i) Sexually transmitted infections (STIs) such as chlamydia, gonorrhea, or syphilis, that can affect the rectum and cause proctitis (inflammation of the rectal lining).

ii). Urinary tract infections (UTIs) such as cystitis (inflammation of the bladder) or pyelonephritis (inflammation of the kidneys), that can affect the bladder and cause vesical tenesmus.

iii) Gastrointestinal infections such as shigella, salmonella, E. coli, campylobacter, C. difficile, amebiasis, or giardiasis, that can affect the colon and cause colitis (inflammation of the colon).

3) Constipation: This is a condition where the stool becomes hard, dry, and difficult to pass, causing infrequent or incomplete bowel movements. Constipation can cause rectal tenesmus by creating a feeling of incomplete evacuation or by irritating the rectal nerves and muscles.

4) Tumors: These are abnormal growths of cells that can occur in the bowel or bladder and cause obstruction, bleeding, or invasion of the surrounding tissues.

– Some examples of tumors that can cause tenesmus are:

i). Colorectal cancer which is a malignant tumor that grows in the colon or rectum and can cause rectal tenesmus, along with changes in bowel habits, blood in the stool, weight loss, and abdominal pain.

ii). Bladder cancer which is a malignant tumor that grows in the bladder and can cause vesical tenesmus, along with blood in the urine, frequent or painful urination, and pelvic pain.

iii). Benign tumors such as polyps, fibroids, or cysts, that can grow in the bowel or bladder and cause tenesmus by compressing or irritating the surrounding tissues.

5) Autoimmune diseases: These are conditions where the immune system mistakenly attacks the body's own tissues, causing inflammation and damage. Some examples of autoimmune diseases that can affect the bowel or bladder and cause tenesmus are:

6) Pemphigus: This is a rare disease that causes blisters and erosions on the skin and mucous membranes, including the mouth, esophagus, and anus.

7) Behçet's disease: This is a rare disease that causes inflammation of various parts of the body, such as the eyes, skin, joints, blood vessels, and nervous system. It can also cause recurrent oral and genital ulcers, as well as ulcers in the bowel.

8) Lupus: This is a chronic disease that causes inflammation of various organs and tissues, such as the skin, joints, kidneys, heart, lungs, and brain. It can also cause oral ulcers, skin rashes, arthritis, nephritis, pericarditis, and neurologic disorders.

SYMPTOMS OF TENESMUS

– Some of the common symptoms and complications of tenesmus are:

• Pain, burning, or tingling sensation in the rectum or bladder.

• Difficulty or urgency to pass stool or urine.

• Straining and discomfort during bowel movements or urination.

• Passing only a small amount of stool or urine.

• Feeling as if the bowel or bladder is not completely empty.

• Fever, malaise, or lymphadenopathy (swollen lymph nodes).

• Dehydration, weight loss, or nutritional deficiencies.

• Infection, sepsis, or systemic inflammatory response syndrome (SIRS).

• Anemia, bleeding, or thrombocytopenia (low platelet count).

– Secondary complications, such as: hemorrhoids, anal fissures, rectal prolapse, urinary retention, urinary incontinence, or bladder stones

DIAGNOSIS OF TENESMUS

– The diagnosis of tenesmus is based on the history, physical examination, and laboratory tests of the patient. Some of the tests that can be used to determine the type, cause, and severity of tenesmus are:

i). Stool or urine tests: These are tests that analyze the stool or urine for the presence of blood, pus, mucus, parasites, bacteria, or fungi that can cause infection or inflammation.

ii). Endoscopy: This is a procedure that uses a flexible tube with a camera and light to examine the inside of the bowel or bladder. Endoscopy can identify the site and cause of the tenesmus, such as ulcers, polyps, or tumors. Endoscopy can also be used to take biopsies (tissue samples) for further analysis.

iii). Imaging tests: These are tests that use X-rays, ultrasound, CT, or MRI to visualize the structures of the abdomen and pelvis, such as the bowel, bladder, kidneys, or liver. Imaging tests can help detect any abnormalities or complications that can cause or result from tenesmus, such as obstruction, perforation, abscess, or cancer.

iv). Blood tests: These are tests that measure the levels of hemoglobin, hematocrit, white blood cells, platelets, electrolytes, glucose, liver enzymes, kidney function, and inflammatory markers in the blood. They can help assess the extent of blood loss, infection, inflammation, or organ damage caused by tenesmus.

v). Serology tests: These are tests that detect the presence of antibodies or antigens in the blood that are associated with certain infections or autoimmune diseases that can cause tenesmus. Some examples are HSV-1, HIV, HCV, EBV, CMV, syphilis, Candida, Entamoeba, Leishmania, pemphigus, or lupus.

TREATMENT OF TENESMUS

– The treatment of tenesmus depends on the cause and severity of the condition. Some of the treatment options include:

• Medications: These are drugs that can reduce inflammation, infection, acid production, or bleeding in the bowel or bladder. Some examples are antibiotics, antivirals, antifungals, anti-inflammatory drugs, proton pump inhibitors, H2 blockers, antacids, sucralfate, or octreotide.

• Fluids and blood transfusions: These are interventions that can restore the fluid and blood volume that is lost due to tenesmus. Fluids and blood transfusions can prevent dehydration, shock, and anemia.

• Surgery: This is an option that can be used to remove or repair the source of tenesmus, such as ulcers, tumors, polyps, or perforations. Surgery can also be used to create a bypass or shunt to reduce portal hypertension and prevent variceal bleeding.

• Lifestyle changes: These are modifications that can help prevent or reduce the recurrence of tenesmus. Some examples are avoiding alcohol, tobacco, spicy, acidic, or hard foods that may irritate the bowel or bladder or trigger tenesmus.

• Supportive care: This includes measures that can relieve the pain and discomfort of tenesmus, such as using laxatives, enemas, or suppositories to ease bowel movements, using analgesics or antispasmodics to ease bladder spasms, or using topical anesthetics or analgesics to numb the affected area .

– The choice of treatment depends on the individual case and the doctor's recommendation. Some cases of tenesmus may resolve on their own without treatment, while others may require more aggressive intervention. The goal of treatment is to treat the underlying cause of tenesmus, prevent complications, and improve the quality of life of the patient.

PREVENTING TENESMUS

– To prevent tenesmus, you should try to treat the underlying cause of the condition, and follow these steps:

• Practice good oral hygiene: Brush and floss regularly, and avoid sharing toothbrushes or utensils with others. This can help prevent oral infections that can spread to the bowel or bladder.

• Avoid triggers: Identify and avoid the factors that may trigger or worsen your tenesmus, such as stress, hormonal changes, food allergies, vitamin deficiencies, or certain medications. You can also try to avoid biting, scratching, or burning your mouth, which can irritate the mucosa.

• Use natural remedies: Some natural remedies may help soothe and heal your tenesmus, such as rinsing your mouth with salt water, baking soda solution, or apple cider vinegar, applying ice, cold compresses, or aloe-vera gel, or taking vitamin supplements.

• Seek medical help: If your tenesmus is severe, persistent, or recurrent, or if you have signs of complications, such as fever, dehydration, or bleeding, you should seek medical help. Your doctor may prescribe medications, such as antibiotics, antivirals, antifungals, or steroids, to treat the underlying cause of your tenesmus. You may also need endoscopy or surgery to remove or repair the source of tenesmus.

– These are some of the ways you can prevent or reduce the recurrence of tenesmus. However, you should always consult your doctor before trying any home remedies, as they may not be suitable for your condition or may interact with your medications. You should also follow your doctor's advice for treatment and prevention of tenesmus.

Can I use antibiotics for tenesmus?

– Antibiotics may be helpful for tenesmus if it is caused by a bacterial infection of the bowel or bladder, such as sexually transmitted infections, urinary tract infections, or gastrointestinal infections. However, antibiotics are not effective for tenesmus caused by other factors, such as inflammatory bowel disease, tumors, or autoimmune diseases. Therefore, you should always consult your doctor before using antibiotics for tenesmus, as they may not be suitable for your condition or may interact with your medications. Your doctor will prescribe the appropriate type and dose of antibiotics based on the type and severity of your infection. You should also follow your doctor's advice for treatment and prevention of tenesmus.