Incomplete evacuation, also known as rectal tenesmus, refers to the sensation of being unable to completely empty the bowels. This uncomfortable feeling is quite common and has a number of potential causes. Here is an overview of what incomplete evacuation feels like, what might cause it, and tips for dealing with it.
The Sensation of Incomplete Evacuation
The main symptom of incomplete evacuation is the persistent feeling of needing to pass stool, even though nothing comes out when visiting the bathroom. This urgent feeling may come and go in waves. It often leads to straining or excessive wiping in an attempt to fully empty the rectum.
In addition to the sensation of rectal fullness, other symptoms can include:
- Feeling like you can’t fully relax the anal sphincter
- Cramps or spasms in the lower abdomen or rectum
- Passing small amounts of mucus or liquid stool
- Fecal leakage or soiling
These symptoms arise because stool remains lodged in the rectum after a bowel movement. The rectum is unable to fully clear itself, leading to the persisting feeling of needing to go. This can be quite frustrating and uncomfortable.
What Causes Incomplete Evacuation?
There are several possible explanations for feeling like you can’t completely empty your bowels:
Constipation
Constipation is one of the most common causes of incomplete evacuation. When stool becomes hardened and difficult to pass, it can get stuck higher up in the colon. Softer stool may be able to pass around the blockage, leading to bowel movements that feel unsatisfactory.
Pelvic Floor Dysfunction
The pelvic floor muscles help control bowel movements. If these muscles are weak, straining or impaired coordination when trying to have a bowel movement may leave stool behind in the rectum. Pelvic floor dysfunction is common after pregnancy and childbirth.
Hemorrhoids
Swollen hemorrhoids can obstruct the anus, making it difficult to fully empty the bowels. They may also make bowel movements painful, causing people to try to limit straining.
Anal Fissures
Anal fissures are small tears in the lining of the anus. Passing stool over these tears can be very painful, which can lead people to cut bowel movements short before fully evacuating.
Rectal Prolapse
A rectal prolapse occurs when the rectal walls lose muscle tone and essentially turn “inside out” through the anus. This can create a blockage preventing complete evacuation. It often causes a feeling of needing to move bowels even when little comes out.
Damaged Nerves
Nerves control the muscle contractions that enable bowel movements. If these nerves are damaged, such as from diabetes, spinal cord injuries, or after certain surgeries, the rectum may not fully empty.
Medications
Some medications like narcotic pain medicines, antidepressants, iron, and calcium channel blockers can cause constipation. The resulting hardened stool increases the likelihood of incomplete evacuation.
Irritable Bowel Syndrome
People with irritable bowel syndrome (IBS) often deal with bouts of constipation alternating with diarrhea. During the constipation periods, incomplete rectal emptying is very common.
Anorectal Angle Issues
Normally, the anorectal angle (the angle at which the rectum meets the anus) is around 90 degrees when sitting on the toilet. This straightens out the rectum, allowing easy passage of stool. Some people have abnormal positioning where this angle bends too sharply, making it hard to fully evacuate.
When to See a Doctor
Feeling like you can’t completely empty your bowels is often manageable with home remedies and lifestyle changes. However, see your doctor if:
- Symptoms last longer than 2 weeks
- You have bloody stool
- You are losing weight unexpectedly
- Symptoms are severely impacting your daily life
This can indicate a more serious medical condition requiring proper diagnosis and treatment. Seek emergency care for fever over 101 F, vomiting, severe abdominal pain, or inability to have a bowel movement or pass gas.
Diagnosing Incomplete Evacuation
To diagnose the cause of incomplete evacuation, your doctor will ask about your symptoms and medical history. Be prepared to describe your bowel habits in detail. Tests may include:
- Digital rectal exam – Your doctor inserts a gloved, lubricated finger into the rectum to feel for any abnormalities.
- Colonoscopy – A tiny camera on a flexible tube is inserted in the rectum to directly visualize the colon and rectum.
- Anorectal manometry – Measures pressures and muscle contractions in the anus and rectum.
- Anal ultrasound – Uses soundwaves to create images of structures in the anus.
- Defecography – You sit on a toilet inside an x-ray machine to evaluate how well stool empties.
- Blood tests – Check for causes like diabetes, thyroid disorders, celiac disease, or infections.
Your doctor will review your test results and symptoms to determine the underlying cause and best treatment options.
Treatments for Incomplete Evacuation
Treating the underlying disorder causing incomplete evacuation is key. Possible treatment approaches can include:
- Laxatives and stool softeners – Osmotic laxatives that helpdraw water into the colon are often recommended for chronic constipation. Stool softeners like docusate allow stools to pass more easily.
- Biofeedback therapy – You learn pelvic floor muscle control and relaxation techniques to improve coordination during bowel movements.
- Surgery – Removal of obstructions, repairing rectal prolapse, or sphincter surgery may be warranted depending on the diagnosis.
- Medication adjustments – Switching medications causing constipation or trying IBS prescription medicines.
- Dietary changes – Increasing fiber, fluids, probiotics can help treat and prevent constipation.
- SitBath – Warm water baths for the buttocks and anal area can help relax pelvic floor muscles.
Finding the right solutions takes some trial and error. Be patient and keep your doctor informed of any ongoing issues with incomplete bowel movements.
Coping with the Discomfort
In addition to pursuing medical treatment, there are some self-care tips that can help manage the uncomfortable feeling of being unable to fully empty your rectum:
- Try splinting – place a rolled washcloth under your tailbone while sitting on the toilet to help straighten the anorectal angle.
- Go when the urge strikes – holding back bowel movements can worsen constipation issues.
- Try elevating your feet on a stool while sitting on the toilet.
- Perform pelvic floor relaxation exercises.
- Apply a warm compress to the perineal area for comfort.
- Avoid excessive straining, allowing gravity to gently assist.
- Wipe gently with moist wipes to avoid irritating tender areas.
Making dietary changes, staying active, and reducing stress can also help manage symptoms in the long run. Track your bowel habits to identify patterns and possible triggers.
When to Seek Emergency Care
While incomplete evacuation is normally not a medical emergency, you should seek prompt medical attention if you experience:
- High fever over 101 F
- Bloody diarrhea
- Vomiting and inability to keep down fluids
- Severe, worsening abdominal pain
- Inability to have a bowel movement or pass gas for 2 days
These can signal a serious medical issue requiring hospitalization, like a bowel obstruction, perforation, or toxic megacolon. Go to an emergency room or call 911 if your symptoms seem life-threatening.
Preventing Incomplete Evacuation
Making some positive lifestyle changes may help prevent frustrating episodes of incomplete evacuation:
- Drink plenty of fluids, at least 8 glasses of water daily.
- Eat more high-fiber foods like fruits, vegetables, beans, and whole grains.
- Exercise regularly, aiming for at least 30 minutes per day.
- Reduce stress through techniques like yoga, meditation, or journaling.
- Consider probiotic supplements to improve gut health.
- Use the bathroom as soon as you feel the urge, don’t delay.
- Avoid straining excessively during bowel movements.
Pay attention to which foods tend to trigger constipation for you. Limiting dairy, red meat, processed foods, and sugary treats can help some people. Give your doctor a head’s up if constipation persists despite lifestyle measures.
Outlook for Incomplete Evacuation
While the persistent feeling of being unable to fully empty your bowels can be highly bothersome, the outlook for improvement is often good once the underlying cause is identified and treated. Simple remedies can help manage symptoms in the short term.
Try to have patience discovering the strategies and treatments that provide you the most relief. Communicate openly with your healthcare provider so they can help get your bowel habits back on track.
With proper management, most people find they are able to achieve complete evacuation the vast majority of the time. Seek medical assistance if lifestyle measures and over-the-counter approaches are not providing sufficient relief from the discomfort of incomplete bowel movements.
