Tenesmus

TENESMUS (from Greek teinesmos - hard, tense abdomen), a painful, distressing urge to defecate (tenesmus alvi) or urinate (tenesmus urinae) without complete evacuation of contents or without any effect at all. The same symptom, but without the painful reaction, is called a false urge. The mechanism of tenesmus consists of spasmodic contraction of the smooth muscles of the large intestine (mainly the rectum and sigmoid) and the bladder, followed by contraction of the voluntary muscles of the pelvic floor and perineum (sphincter ani externus, levator ani), as well as the abdominal press. Simultaneous spasmodic contraction of some muscles without corresponding relaxation of others (especially the sphincters) hinders the beneficial effect and prevents the removal of contents from the rectum or bladder, or leads to the expulsion of small portions of urine, feces, mucus, blood, or pus - depending on the pathological process that is the primary cause of the tenesmus. The muscular hypertonia underlying tenesmus depends both on irritation of the autonomic nerve plexuses of the muscular wall itself and on irritations coming along the hypogastric and pelvic nerves from the central nervous system. Like false urges, tenesmus (tenesmus alvi) is a specific reaction of the rectum to various irritants. According to Pevzner, the primary site of tenesmus is always the rectum; according to Straus, it is also the sigmoid flexure. Among the diseases leading to tenesmus, first place is occupied by various afflictions of the rectum and sigmoid: hemorrhoids, proctitis, sigmoiditis, fissures, fecal tumors, fistulas, polyps, adenomas, cancer, strictures, periproctitis, pararectal lymphadenitis; then diseases of the bladder and neighboring organs: cystitis, prostatitis, tuberculosis, bladder and ureteral stones, sensitive bladder neuroses (cystospasm and so-called stuttering bladder), gynecological diseases, pelvic tumors, processes in the coccygeal and sacral bones. In the second place, mention should be made of general diseases of the large intestine: all forms of dysentery, tuberculosis, colitis, pericolitis; tenesmus is significantly rarer in enteritis, cholera, and typhoid diarrhea. Tenesmus can also be caused by diseases of the central nervous system, for example, tabes (rectal crises), myelitis. A special form of tenesmus is the so-called perineal crises (Eisner), resulting from spasm of the internal sphincter after particularly abundant, voluminous stools, frequent diarrhea, or prolonged riding in an automobile or train. Finally, Straus notes as a rare condition a special idiopathic proctospasm as a cause of tenesmus. Among the consequences of tenesmus are prolapse of the mucous membrane, retention of urine and feces, pruritus of the anal and vaginal regions. The treatment of tenesmus generally coincides with the treatment of acute proctitis: insertion into the anus of suppositories with belladonna, papaverine, or opium; insertion of a pessary with vaseline (like the suppositories), which leads to relaxation of the spasm; a T-shaped catheter of soft or hard rubber or glass, or even an ordinary enema tube or Nelaton catheter with a T-shaped tube and funnel for passing warm fluid for 1-2 minutes - first physiological solution of sodium chloride or 1% soda or lime water to wash away mucus and remove feces, then solutions of chamomile, protargol ¹/₄-72°/oo> silver nitrate ^g/_g-1%₀, potassium permanganate '/₆-7з%o ^{or жо} absorbing enemas of chamomile or dermatol, to which a few drops of tincture of opium can be added. Such treatment is only causal in cases of inflammatory disease of the rectum; in other cases it is only symptomatic; in these cases one should try to affect not only the rectum but the primary cause of the tenesmus, i.e., to treat the underlying condition. Local therapy through a proctoscope is possible only after the cessation of acute irritation phenomena.