Tenesmus is sometimes referred to by Crohn’s disease patients as painful bowel movements or difficulty in passing a stool. The National Institutes of Health (NIH) online encyclopedia defines tenesmus as “the constant feeling of the need to empty the bowel, accompanied by pain, cramping, and involuntary straining efforts” (www.nlm.nih/gov/medlineplus/ency/article/003131.htm ). It is usually accompanied by a sudden and sharp pain in the perianal area.
Tenesmus can be baffling to Crohn’s patients. Most of us are accustomed to sudden and frequent bouts of diarrhea; to have the precursors of that diarrhea – the cramping, pain and urge to go – and then produce nothing is a little frightening. People with Crohn’s disease, or any inflammatory bowel disease (IBD), are often warned by their doctors of the possibility of narrowing or blockage of the intestines, and when they experience this inability to pass anything, usually it is a blockage that comes to mind and not tenesmus. Many physicians fail to even mention or explain tenesmus to their Crohn’s patients (until they have it), causing further confusion for the patient.
Sometimes tenesmus can be treated at home by increasing the intake of both fiber and fluids. This is not always pleasant; some Crohn’s patients experience pain and cramping throughout the intestinal tract when they increase fiber consumption during a relapse or flare.
If tenesmus continues for more than a day, whether it is constant or off-and-on, Crohn’s patients should see their physician as soon as possible, especially if it is accompanied by nausea and/or blood in any stool they are able to pass. Tenesmus can be an indication of more serious problems, such as an infected pus pocket, that only a physician can determine using a variety of tests, including blood work and the inevitable endoscopy or colonoscopy. Patients should not be embarrassed to describe their symptoms as clearly and in as much detail as possible. Likewise, physicians should not use medical jargon when answering or asking their patients’ questions. Not all patients use the word “stool” for feces, for example.
If tenesmus is diagnosed, and increased fluid and fiber aren’t working, most physicians will prescribe one or two treatments for their Crohn’s patients. If blood tests indicate an elevated white count, the presence of an infection (one possible cause of tenesmus with Crohn’s disease), an antibiotic will be prescribed. For adults, it is usually ciprofloxin (Cipro) or metronidazole (Flagyl). In children and adolescents, it is usually metronidazole. Until recently, ciprofloxin wasn’t used in children because of safety concerns, but recent testing has shown that it is, in fact, as safe in children at the appropriate dosage as it is for adults. Patients taking metronidazole should be warned that this drug should not be used with alcohol because of a severe reaction.
Whether infection is present, a topical treatment for tenesmus is generally prescribed for Crohn’s patients. A 5-aminosalicylate (5-ASA) compound may be given either as a suppository or an enema. If a 5-ASA is already being taken orally (usually either mesalamine [Pentasa, Rowasa, or Asacol] or olsalazine [Dipentum], because sulfalazine has many side effects), a corticosteroid may be given either as an enema or a foam. In cases where the urgency and/or pain of tenesmus is especially severe, a foam application may be easier for the Crohn’s patient to tolerate. Topical application has the further advantage for Crohn’s patients of reducing the side effects associated with the use of corticosteroids.
For Crohn’s patients, tenesmus is likely to occur at some point, usually during a relapse or flare of the illness. The good news is that tenesmus can be treated relatively easily; the bad news is that tenesmus will probably return at some point.
Reference:
- www.ccfa.org (Crohn’s and Colitis Foundation of America)
