
Hi- This Is Quite An Embarrassing Questions With Even More

For quite some time now, I have been having extremely strange issues with my stomach. It is usually 1 of a few things:
1. I almost constantly have a feeling as if I need to use the bathroom. But no matter how many times I attempt, there is never any bowel movements.
2. This feeling is almost always intensified right after I eat. It does not feel like a serious urge, but more of like a "pressure". Still, it is not uncommon for me to take a trip to the bathroom several times in an hour. And again, in the vast majority of cases, there is no bowel movement. It has even gotten to the point now that I am hesitant to spend extended periods of time outside of my apartment (I am convinced that this particular aspect is mental). Still, though, the "feeling" seems to always be there.
3. In rare cases when I do have a bowel movement, it is as if it comes instantaneously out of nowhere, and it is usually an embarrassing level of uncontrollable.
I have looked online at many of the "usual" causes of these sorts of things, and I seem to almost never experience any of the other symptoms. No bleeding anywhere, no inflammation (in any area that I can notice at least) and no actual stomach pain.
Again, it is just the constant "feeling as I have to go" rather than the actual need. And like I mentioned, that feeling is almost always intensified immediately after I eat.
I'm not sure if this makes any sense or if this information is helpful.
Possible causes and further needed examinations explained below
Detailed Answer:
Hello and welcome to 'Ask A Doctor' service,
I read your query carefully and understand your concern. You have well explained your symptoms.
The need to go to the toilet and not being able to defecate (pass stools) is called tenesmus. There are several possible causes of it. A common cause is an irritable bowel syndrome where the bowel is overactive and causes symptoms but there is no physical finding to justify this.
Other conditions such as inflammatory bowel disease, bowel infection and food intolerance are possible conditions.
Sometimes if patients are involved in rectal intercourse, proctitis due to gonorrhea (a sexually transmitted infection) can be a cause as well.
Because the symptoms are worse after eating food probably food intolerance or irritable bowel syndrome are the most likely causes.
On the other hand, because you already have these symptoms for more than 3 months it is important that you do some tests and examinations to determine the proper cause of it.
A rectal exam with proctoscopy is needed. It is a simple and easy examination done in the office of the general physician and will give plenty of information if there is an inflammation of the rectum or not. According to the results of these, the doctor may decide for a colonoscopy or not (this is a check of your bowel with a tube with a camera).
Stool tests such as stools for ova and parasites, stool microscopy and stool culture are indicated.
Some blood tests might be important as well such as CBC, CRP, blood tests for celiac disease, etc.
If all examinations come out normal then irritable bowel syndrome is likely and this is generally related to stress and anxiety.
To conclude:
- there are many possible causes of tenesmus (increased need to defecate but unable to do so).
- because you have it for so long, you will need tests and examinations as described above (proctoscopy, stool tests, blood tests)
- you may try to use Movicol 2-3 sachets a day meanwhile to help with the transit in the bowel and potentially help you feel better.
I hope this answers your query.
I remain at your disposal for further medical assistance.
Kind regards,
Dr. Antoneta Zotaj,
General and Family Physician

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