Causes of Tenesmus

Inflammatory Bowel Disease

The American Gastroenterological Association notes that tenesmus is a cardinal symptom of ulcerative colitis, occurring alongside bloody diarrhea, urgency, and colicky abdominal pain 1, 2.
The European Crohn's and Colitis Organisation reports that in ulcerative proctitis, tenesmus is particularly prominent and distressing, often accompanied by rectal bleeding, urgency, fecal leakage, and incontinence 3.
Up to one-third of patients with ulcerative proctitis experience constipation alongside tenesmus, according to the American Gastroenterological Association 3.
The European Crohn's and Colitis Organisation states that pouchitis develops in up to 50% of patients within 10 years after ileal pouch-anal anastomosis for ulcerative colitis, with tenesmus being a defining symptom 4, 5.

The Centers for Disease Control and Prevention recommends that proctitis from receptive anal intercourse causes tenesmus limited to the distal 10-12 cm of rectum, with anorectal pain and rectal discharge 6.
The World Health Organization notes that herpes proctitis can be especially severe in HIV-infected patients, causing particularly intense tenesmus 6, 9.
The Centers for Disease Control and Prevention reports that lymphogranuloma venereum serovars of C. trachomatis cause severe proctitis with bloody discharge and perianal ulcers 8, 9.

The American College of Radiology states that approximately 11% of colovesical and colovaginal fistulae are caused by malignancy, which can present with tenesmus 10.
The American College of Radiology notes that carcinomas may rarely arise in chronic anal fistulae in Crohn's disease, presenting with tenesmus and mass-like thickening 10.

The Centers for Disease Control and Prevention recommends that cytomegalovirus causes severe proctitis with tenesmus in immunosuppressed HIV-infected patients 6, 9.
The World Health Organization reports that Mycobacterium avium-intracellulare, Cryptosporidium, Microsporidium, and Isospora can cause enteritis with tenesmus in HIV-infected individuals 6, 9.

The European Crohn's and Colitis Organisation notes that failing to obtain detailed sexual history in patients with infectious proctitis can lead to missing sexually transmitted causes 8, 9.
The American Gastroenterological Association states that not assessing HIV status can dramatically affect disease severity and treatment approach 8, 9.
The European Crohn's and Colitis Organisation reports that assuming all tenesmus in inflammatory bowel disease patients represents active colitis can lead to overlooking pouchitis, cuffitis, or irritable pouch syndrome 5.
The American College of Radiology notes that missing malignancy when soft tissue mass or malignant-appearing lymphadenopathy accompanies anorectal inflammation can lead to delayed diagnosis 10.
The American Gastroenterological Association recommends that medication-induced causes, particularly NSAIDs, should not be overlooked as they can exacerbate ulcerative colitis 2.