TENESMUS

Tenesmus is a very unpleasant recurrent sensation of wanting to move the bowels. It is usually due to pressure on stretch receptors in the levator ani muscles from a pelvic tumor. The same sensation can occur after an abdominal perineal resection of the rectum (when it is known as the “phantom rectum syndrome”). Low doses of morphine and/or chlorpromazine sometimes reduce this sensation.

«  Always exclude impacted feces.

Radiotherapy can be useful when a large cauliflower lesion is filling the rectum. It is contraindicated if there is vaginal involvement because of the risk of a rectovaginal fistula.

High dose steroids (dexamethasone 8mg per day) can help by reducing peri-tumor edema. 

A bi-lateral lumbar sympathetic nerve block is sometimes successful in reducing or abolishing tenesmus.

«  Tenesmus due to large inoperable rectal tumors can be reduced by trans-anal resection or laser therapy. (see Lasers)

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