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Rectal tenesmus is a feeling of incomplete defecation. [1] It is the sensation of inability or difficulty to empty the bowel at defecation, even if the bowel contents have already been evacuated. Tenesmus indicates the feeling of a residue, and is not always correlated with the actual presence of residual fecal matter in the rectum.
Rectal digitation is when patients insert a finger into the anus to "hook" out fecal pellets, [20] or to apply pressure to the walls of the anus and/or the rectum (distension of which may trigger a bowel movement), or to support an obstructing anatomic defect such as a sigmoidocele.
Symptoms include a dull ache more often to the left 2 inches above the anus or higher in the rectum and a feeling of constant rectal pressure or burning. The pain may last for 30 minutes or longer, and is usually described as chronic or intermittent with prolonged periods, in contrast to the brief pain of the related disorder proctalgia fugax.
Vaginal pessaries can immediately relieve prolapse and prolapse-related symptoms. [7] A high fiber diet, consisting of 25–30 grams of fiber daily, as well as increased water intake (typically 6–8 glasses daily), help to avoid constipation and straining with bowel movements, and can relieve symptoms of rectocele. [8] [9]
Dyssynergic defecation causes high pressure in the rectum and in the anal canal, [1] which causes lengthening [1] and compression of the rectal tissues, which in turn leads to ischema of the mucosa. [8] There is also a shearing movement of the rectum against the pelvic floor muscles. [8] In the long term this leads to repeated mucosal damage. [8]
Symptoms are ineffectual straining to empty the bowels, diarrhea, rectal bleeding and possible discharge, a feeling of not having adequately emptied the bowels, involuntary spasms and cramping during bowel movements, left-sided abdominal pain, passage of mucus through the rectum, and anorectal pain.