Tenesmus: what is it?

Tenesmus is an important symptom indicating health problems. They accompany many diseases and require a thorough diagnosis. Treatment is prescribed depending on the cause of the disorder, so it is very important to make a correct diagnosis.

Tenesmus - this concept can be translated from Greek as "ineffectual urge." This symptom may or may not be accompanied by a painful reaction. It represents a specific "response" of the bladder or rectum to any stimulus and is the result of reflex excitation of motor skills. [1]

Epidemiology

Every fourth person on the planet, regardless of age, suffers from tenesmus and discomfort in the pelvic and abdominal cavity. Many diseases are accompanied by very painful spastic attacks, which are repeated 2-3 times a week.

Doctors gastroenterologists and urologists call tenesmus the second most common symptom, after abdominal pain. Doctors of other specialties, for example, therapists, pediatricians, surgeons, encounter such painful symptoms every day.

In the vast majority of patients, tenesmus and abdominal pain are the main symptoms of gastroenterological and urological problems. The causes and development of pathology may differ in different situations. At the same time, the main characteristics of tenesmus of different etiology (localization, period of appearance, duration, intensity, etc.) are not specific and often have much in common, which can provoke diagnostic inaccuracies and lead to the appointment of incorrect treatment.

Causes tenesmus

Since rectal and urinary tenesmus are distinguished, the reasons for their formation may be different. Let's consider them separately from each other.

Rectal tenesmus appears due to such painful conditions:

• Hemorrhoids (expansion of the venous lumen under the influence of varicose veins, an inflammatory reaction or thrombosis). Hemorrhoids, in turn, can have a hereditary etiology, or be the result of obesity, lack of physical activity, excessive physical activity, stress, etc.
• Proctitis (an inflammatory process affecting the rectal mucosa) is associated with frequent constipation, helminthiasis, prostatitis, hemorrhoids, cystitis, etc.
• Sigmoiditis (an isolated inflammatory process in the area of the sigmoid colon) - ischemic and infectious bowel diseases, radiation sickness, granulomatous enteritis and other intestinal lesions contribute to its appearance.
• Fecal stones (accumulation of dense fecal masses in the lumen of the rectum, which, when probing the abdomen, can mimic the tumor process).
• Fistulas (appear as a complication of a chronic inflammatory reaction in the peri-rectal tissue, anal pockets or in the space between the sphincters).
• Polyps (numerous or single growths on mucous tissues) - appear on the site of the inflammatory process, hyperplasia, etc.
• Adenoma (growth of a benign nature, which, under certain circumstances, may have a tendency to malignancy).
• Adenocarcinoma (malignant disease arising from the cellular structures of the glandular epithelium).
• Stenosis, accompanied by a narrowing of the rectal lumen due to inflammation, tumors or congenital anatomical disorders.
• Periproctitis (a purulent inflammatory reaction in the peri-rectal tissue) is the result of inflammation of the rectum or hemorrhoids.
• Pararectal lymphadenitis (inflammation of the lymph nodes when an infection enters them). [2]

No less common causes of rectal tenesmus are:

• intestinal tuberculosis, enterocolitis, typhoid fever, dysentery, etc.;
• spinal cord inflammation, thyrotoxic crisis;
• perineal crisis syndrome;
• proctospasm of unexplained etiology.

Tenesmus is also characteristic of irritable bowel syndrome, in which vegetative disorders, dysbiosis, and nervous disorders are observed. [3]

Bladder tenesmus develops due to the following reasons:

• Cystitis (an inflammatory reaction associated with the penetration of an infectious agent into the bladder) - can occur against the background of a sharp weakening of immunity, eating disorders, diabetes mellitus, etc.
• Prostatitis (inflammation of the prostate) - often associated with physical inactivity, PPN infections, prolonged abstinence, etc.
• Increased urethral stone formation - due to impaired metabolism, insufficient intake of vitamins into the body.
• Neurogenic bladder is a disease associated with malfunctioning of the central nervous system and autonomic NS.
• Gynecological pathologies (tumor or inflammatory processes of the reproductive organs, endometrioid growths).
• Tumor processes in the small pelvis.
• Bone inflammation in the lower segments of the spinal column. [4]

Risk factors

A number of factors lead to the appearance of tenesmus:

• violation of the central nervous system and autonomic nervous system;
• pronounced violation of the quality of the intestinal microflora (dysbiosis);
• metabolic disorders;
• inflammatory processes;
• trauma to the abdominal cavity, pelvic area, perineum;
• improper nutrition;
• alcohol abuse, smoking;
• psychical deviations;
• hypodynamia, excessive physical overload;
• stress, social and emotional factors.

At the same time, malnutrition, hypothermia, alcohol and tobacco use are considered the basic global factors. Such factors, among other things, increase the risk of chronic pathologies. An important role is played by a low level of sanitation and hygiene, unsuitable water for drinking, and poor-quality food. [5]

Pathogenesis

The process of the appearance of tenesmus is closely related to spasms and muscle contractions:

• smooth intestinal muscles (mainly the rectum and sigmoid colon are involved);
• smooth muscle fibers of the bladder.

Irritating factors cause an increase in the contractile activity of the abdominal, perineal and pelvic muscles. Due to the simultaneous spasm of one muscle group and the lack of relaxation on the part of the other group (as well as the sphincters), the excretion of feces or urinary fluid is significantly complicated. In some cases, there is a "pushing" of a small amount of feces. [6]

In some patients with tenesmus, mucous, purulent or bloody discharge is possible, which is due to the underlying disease, which provoked the appearance of painful symptoms.

During tenesmus, intramuscular tension increases, which is a consequence of irritating effects:

• on the nerve plexuses of the muscles;
• on the hypogastric nerves and nerve endings of the pelvic plexus.

One of the main factors that can provoke painful contractions is a functional failure in the central nervous system. Such tenesmus is chaotic and ineffectual.

Symptoms tenesmus

Tenesmus is a "deceiving" urge of the body, during which a person expects to perform an act of urination or defecation, but in fact nothing like that happens. Only in some cases is a very small amount of feces or mucus excreted. Unpleasant sensations are often accompanied by pain, spasms. However, the condition returns to normal after the end of tenesmus.

The pain is more disturbing in the perianal zone. Symptoms may gradually increase and then stop abruptly.

Tenesmus is characterized by:

• cramps and pain in the lower abdomen;
• intense urge to excrete urine or feces;
• lack of result from the urge (urine or feces are not excreted at all, or come out in extremely small quantities).

In the urinary fluid or feces, you may notice the presence of mucous or purulent discharge (not always). In some patients, erosions are observed in the anal area.

The first signs are not always the same, they are subtle or pronounced. For example, with severe tenesmus, rectal prolapse occurs, and with lungs, itching is possible in the perianal and vaginal regions. [7]

Intestinal tenesmus

The most common cause of intestinal tenesmus is inflammatory bowel disease. Sometimes these symptoms are observed with prolonged digestive disorders, with the accumulation of feces in the intestinal cavity. Often, helminths, as well as the use of hard-to-digest and rough food (especially against the background of overeating), become "culprits".

By the type of localization of tenesmus, the affected area of the intestine can be determined:

• navel zone - pathology of the small intestine;
• right-iliac zone - ileitis;
• the lower segment of the abdomen, mainly on the left side - left-sided pathologies of the large intestine;
• the right-iliac zone and the lateral abdominal walls on the right are right-sided pathologies of the large intestine.

Tenesmus can be permanent, but more often they are acute, growing. The latter usually indicate an acute process requiring emergency medical care. Recurring unexpressed (aching) tenesmus is most often caused by chronic intestinal or retroperitoneal pathologies. [8]

Rectal tenesmus

Tenesmus, which is often referred to as rectal colic, is a special type of clinical manifestation. Such painful symptoms occur against the background of irritation of the rectum and nearby organs. They are manifested by very frequent and unpleasant urges to remove feces, with sensations of convulsive spasm in the rectal and sphincter zones. In this case, defecation is not carried out, since the lumen of the rectum is either empty or filled with only a certain amount of inflammatory secretions.

The most severe course of tenesmus is observed in the acute form of dysentery , with the lowering of the inflammatory reaction in the lower intestine. Similar symptoms are also observed with other inflammation or ulcerative processes in the rectum. 

Tenesmus with hemorrhoids

Tenesmus has a different diagnostic value, depending on the moment of their appearance. So, the onset of painful urges before defecation indicates a lesion of the descending colon or sigmoid part of the intestine.

Pulling sensations during defecation during the passage of feces, as well as subsequent "empty" tenesmus, allow one to think about the presence of a pathological process directly in the rectum. This sometimes happens in patients with hemorrhoids, anal fissures, etc.

Hemorrhoids are a common cause of rectal pain. Moreover, the symptomatology largely depends on where the pathological process is located. Internal damage can occur on the inner surface of the rectum, but it can diverge further - as the disease worsens. [9]

Hemorrhoids cause various symptoms, ranging from mild discomfort to severe painful tenesmus and thrombosis. A sharp or throbbing pain appears, which can last for several days. Tenesmus is mainly accompanied by difficulties with the excretion of feces, the appearance of perianal edema, bumps in the anal area.

Pain during tenesmus is usually sudden and severe, lasting less than a minute (sometimes longer). This symptom is caused by muscle spasm in the rectal muscles. [10]

Mucus with tenesmus

The secretion of mucus instead of feces in tenesmus usually indicates an inflammatory process in the small or large intestine. Together with mucus, clots or streaks of blood, pieces of feces can come out.

A patient with such symptoms should undergo a full course of diagnostics, since there are many diseases accompanied by this painful symptom.

Treatment is prescribed, depending on the identified pathology. As a rule, its main points are:

• normalization of intestinal motility and the formation of feces;
• restoration of an adequate digestive process and assimilation of nutrients;
• eradication of the adverse effects of impaired intestinal function;
• prevention of recurrence of tenesmus and underlying disease.

The secretion of mucus and other pathological secretions in conjunction with tenesmus is a sign that cannot be ignored. It is necessary to consult a doctor without wasting precious time trying to self-medicate.

Blood with tenesmus

Bloody discharge during tenesmus is often caused by hemorrhoids, rectal fissures, ulcerative processes in the intestinal wall - for example, with duodenal ulcer or ulcerative enterocolitis. Often this symptom occurs against the background of varicose veins of the rectum.

The most common cause is hemorrhoids in patients with long-standing hemorrhoids, or anal fissures.

If intestinal bleeding is present, bloody stools are usually observed .

If feces of a dark (almost black) color are noted, this means that there is bleeding of the upper intestinal regions. Discharge of scarlet blood during tenesmus indicates damage to the lower segment of the intestine.

With abundant or prolonged blood loss, corresponding signs are found:

• headache, dizziness;
• noise in the head, ears;
• feeling tired, weak;
• pallor of the skin, circles under the eyes;
• weakness of heart function;
• less often - impaired consciousness, up to fainting.

If there are signs of intestinal bleeding, it is imperative to seek medical attention. With large blood loss, hospitalization of the patient is required.

Diarrhea with tenesmus

It is considered normal if a person performs an act of defecation 1-2 times a day. If trips to the toilet occur more often - more than 4 times a day - and the feces have a liquid consistency, then they talk about the development of diarrhea, or diarrhea. This pathological condition, together with tenesmus, indicates accelerated intestinal motility and increased passage of food and feces through the intestines.

The appearance of diarrhea is always associated with disorders of the motor and secretory function of the colon. If everything is normal in this section of the digestive tract, then there should be no diarrhea. With the development of disturbances, motor skills increase, feces liquefy and begin to move rapidly through the colon. [11]

At the same time, intestinal secretion increases and its absorption capacity decreases. Diarrhea can be accompanied not only by tenesmus, but also flatulence, rumbling sounds and abdominal pain. First of all, the disease should be distinguished from poisoning or intestinal infection.

Painful tenesmus

If tenesmus is not accompanied by pain, then they simply speak of "empty" urges. But quite often the urge appears simultaneously with painful sensations, sometimes very strong. Such a complex of symptoms in many cases is a sign of pathology of the colon, rectum or sigmoid colon - for example, we can talk about inflammatory processes, neoplasms, polyps, etc. In addition, patients are often diagnosed with:

• proctitis and paraproctitis;
• Crohn's disease ;
• hemorrhoids;
• infectious processes ( salmonellosis , dysentery, etc.);
• irritable bowel syndrome.

In some situations, false tenesmus are neurogenic in nature and are separate manifestations of neuroses and other similar conditions. In rare cases, they become signs of diseases of the central nervous system.

Bladder tenesmus

Signs and manifestations of bladder tenesmus may vary in each patient. Characteristics change in the course of the pathology - for example, they increase with PMS in women , appear during stress or sexual intercourse.

Additional signs of bladder tenesmus are often the following:

• pain in the pelvic area, or between the anus and the vagina in women and between the anus and the scrotum in men;
• frequent urination in extremely small volumes;
• a feeling of fullness in the pelvic region;
• anxiety, irritability.

Such painful sensations always indicate a serious health problem. It is important to consult a doctor in a timely manner to diagnose and prescribe a comprehensive treatment. It may take some time before the doctor selects an individual effective therapy. Physiotherapy may be prescribed to help reduce the frequency and intensity of seizures if they are caused by a spasm of the pelvic floor muscles. One of the options for such treatment is the Urostim apparatus, which represents a biological feedback with electrical stimulation of the pelvic floor muscles. [12]

Tenesmus in children

The appearance of tenesmus in infants is possible due to developmental defects - for example, if any segment of the intestine is narrowed or lengthened. Such defects are often caused by:

• Down syndrome;
• polyhydramnios in a woman during pregnancy;
• diabetes in a woman.

Frequent tenesmus causes pain in the child, so he cries, shows great anxiety, strains to no avail, turns around.

At an older age, tenesmus in children is caused by inflammatory and infectious processes in the body, dysbiosis, psychoemotional disorders. When diagnosing, the doctor must exclude polyposis, diverticulosis, intestinal and parasitic infection, Crohn's disease, tuberculosis, dolichosigma . In some cases, painful attacks occur with neuroendocrine tumors, thyrotoxicosis, diabetes mellitus with autonomous diabetic enteropathy.

Against the background of tenesmus, children are often characterized by symptoms such as intense abdominal pain, rectal bleeding, lactose, gluten and fructose intolerance, and fever. When these signs appear, contacting a doctor should be mandatory and urgent.

Forms

Tenesmus is divided into two categories depending on their location:

• urinary;
• intestinal.
• There is also a clinical classification according to the options for the course of tenesmus:
• with bloating and abdominal pain;
• with frequent loose stools;
• with constipation.

Such a division is conditional, since many patients have a combination of painful symptoms, or their transformation from one form to another (for example, the absence of defecation is replaced by diarrhea, or vice versa).

Complications and consequences

Lack of medical care, or improperly prescribed therapy are the factors, due to which complications such as:

• anal or vulvar varicose veins;
• rectal cracks;
• intestinal obstruction;
• impaired absorption and assimilation of food (as a result - anemia, hypovitaminosis, metabolic disorders);
• pathologies of the upper digestive system (for example, gastroduodenitis).

Attempts to self-medicate for tenesmus - in particular, taking painkillers - can lead to various complications, including those that pose a danger to the patient's life. At the same time, attempts to “endure” a painful condition without therapy contribute to the chronic transformation of the existing pathology, the development of severe forms of the disease, and a deterioration in the quality of life. Therefore, if you are not indifferent to your health, if suspicious painful symptoms appear, you should immediately, preferably at the initial stage of pathology, consult a doctor.

Diagnostics tenesmus

To determine the cause of the appearance of unpleasant symptoms, you first need to make a diagnosis - that is, find the disease that provoked tenesmus.

Laboratory research includes the following analyzes:

• general clinical blood test - demonstrates inflammatory changes, the presence of anemia;
• blood biochemistry - allows you to assess the function of internal organs, helps to determine the presence of an inflammatory process and metabolic disorders;
• coprogram (microscopic examination of feces) - allows you to identify failures in the mechanism of food digestion;
• examination of feces for occult blood - helps detect hidden bleeding in the intestines;
• sowing feces in case of suspicion of acute infectious intestinal lesions. [13]

Instrumental diagnostics is also mandatory and includes the following studies:

• Irrigoscopy is one of the many options for X-ray diagnostics. The research process is as follows: through the anus into the rectal cavity, a contrast is introduced - a special substance that has the ability to clearly visualize on the monitor of an X-ray device. The procedure allows you to consider the presence of an inflammatory reaction, tumor processes and other factors in the occurrence of tenesmus in a patient.
• Colonoscopy is one of the basic types of diagnostics of intestinal pathologies. It helps to visually assess the condition of the mucous intestinal tissues, since a special camera is used in the diagnosis. During the procedure, it is possible to conduct a biopsy - removal of a tissue particle for further laboratory research. This point is very important when you suspect benign or malignant tumor processes.
• Magnetic resonance imaging and computed tomography are considered additional methods for making and clarifying the diagnosis. These diagnostic procedures allow you to step by step consider the necessary structures, determine the depth, prevalence and exact location of the disease process. [14]

Differential diagnosis

Differential diagnosis is carried out with tumor processes, acute intestinal infections, inflammatory diseases of the urological or digestive tract. In patients, it is necessary to exclude diverticulosis, colorectal cancer, ischemic colitis, polyposis and other organic lesions. [15]

Treatment tenesmus

The treatment regimen for the disease that provoked the appearance of tenesmus is developed by the treating doctor after the final diagnosis is made. Timely start of treatment is also important, as this will prevent the development of complications and accelerate healing.

In almost all cases of diseases of the bladder and digestive tract, the doctor prescribes a diet. If tenesmus accompanies an acute form of pathology, then for some time the nutritional components can be administered parenterally, bypassing the digestive tract. Gradually, the patient is returned to normal food intake, with the exclusion from the diet of foods that can provoke a repeated exacerbation of the disease. [16]

Treatment of the underlying disease can be carried out in stages. For example, in acute gastroenteritis, the excretory function is first normalized, then antibiotics are prescribed, and after them - drugs that restore the composition of the intestinal microflora, regenerate mucous tissues, and improve metabolism in the body.

The duration of treatment varies. If some pathologies can be cured in 1-2 weeks, others may require more prolonged therapy. And chronic pathologies can "stay" with the patient for life.

In some cases, including urgent acute conditions, as well as with ineffectiveness of drug treatment and further progression of the disease, surgical care is indicated. Interventions can be cavity or minimally invasive (laparoscopic), depending on the scale of the pathology. [17]

Medicines

Symptomatic treatment is aimed directly at ridding the patient of painful attacks - tenesmus. As a rule, the doctor prescribes antispasmodics - medicines that eliminate spasm of the smooth muscles of the intestine, which leads to relief of pain and restoration of intestinal motility.

The most commonly prescribed drugs from this group are:

Drotaverin (No-shpa)	Shows effectiveness in tenesmus of muscle and nervous origin. Acts on smooth muscles of the digestive, biliary, and genitourinary systems. The average daily dosage for adults is 3-6 tablets (2-3 doses). The duration of therapy is determined individually.
Mint tablets	A drug with a moderate antispasmodic, sedative, choleretic effect. Take 1-2 tablets sublingually (for adults - up to 10 tablets per day). The duration of treatment can be different, depending on the effectiveness of the drug.
Papaverine	Myotropic, antispasmodic and antihypertensive drug that reduces the contractile activity of smooth muscles. It is effective for cholecystitis, pylorospasm, spastic colitis, renal colic, etc. It can be administered in the form of tablets or intramuscular injections, at the discretion of the doctor.
Mebeverin	Myotropic antispasmodic drug. Acts directly on the smooth muscles of the digestive tract without affecting normal intestinal motility. It is especially effective for tenesmus caused by irritable bowel syndrome. The standard dosage of the drug is 200 mg twice a day, with water. The course of treatment is continued until a steady improvement in the condition.

Antispasmodics, which directly affect the smooth muscles of the digestive and genitourinary systems, "force" them to relax, which simultaneously affects the disappearance of tenesmus and spasms. Most of these drugs are available over the counter, but should not be taken without a doctor's recommendation.

Some antispasmodics may additionally contain substances that increase the volume of stool. If you intend to take just such funds, it is imperative to ensure a sufficient flow of fluid into the digestive system. Otherwise, the risk of intestinal blockage increases. [18]

Peppermint formulations are thought to reduce the absorption of calcium into the muscles, resulting in muscle relaxation. However, do not expect instant action from mint: it works gently and progressively. True, with severe lesions and acute conditions, mint preparations may not be enough. They are usually used in mild cases.

Side effects of antispasmodics often include headaches, constipation, thirst, and transient visual impairment. Most often, such unwanted symptoms appear with an overdose, as well as in children and the elderly. 

In addition to antispasmodics, the doctor may prescribe the following drugs:

• antidiarrheals (Loperamide) help with loose stools
• laxatives are used for constipation (Metamucil, methylcellulose, calcium polycarbophil);
• tricyclic antidepressants (Amitriptyline, Desipramine, Nortriptyline) are prescribed for severe pain, since these drugs inhibit the conduction of pain signals between the brain and intestines;
• sedatives (Diazepam, Lorazepam, etc.) allow you to eliminate anxiety, which can increase the symptoms of tenesmus;
• antibiotics are prescribed for intestinal and urological infections;
• probiotics are used to restore normal microflora. [19]

Allochol with intestinal tenesmus

Allohol is a combined choleretic agent that contains natural ingredients such as garlic, nettle, dry bile and activated carbon. The action of the drug is based on the properties of its composition:

• garlic improves intestinal peristalsis, suppresses fermentation reactions, eliminates flatulence and inhibits the development of pathogenic flora;
• nettle has choleretic, hemostatic and anti-inflammatory properties, activates digestive processes, improves renal function;
• dry bile stimulates the enzymatic activity of the pancreas and intestines, emulsifies fats and improves their digestion, improves motility, inhibits putrefactive reactions;
• activated carbon is a well-known adsorbent with antidiarrheal and detoxifying properties.

In general, Allochol has the following effect:

• increases the secretion of bile by stimulating the secretory activity of the hepatic parenchyma;
• stimulates the receptors of the small intestinal mucosa;
• increases the osmotic gradient between blood and bile, which explains the osmotic filtration of moisture and electrolytes into the bile system;
• increases bile passage, preventing the ascending movement of the infection;
• prevents precipitation of bile cholesterol.

In addition, Allochol activates bile secretion, improves biliary tone, optimizes cholecystokinin production.

But with an exacerbation of cholecystitis, Allochol cannot be used: in such situations, antibiotic therapy is indicated, and for pain and tenesmus, antispasmodics are prescribed.

With tenesmus of intestinal or urinary origin, the drug is taken 1-2 tablets up to 3-4 times a day after meals, for a month. Then they switch to the scheme of taking 1 tablet 2-3 times a day for 4-6 weeks. A positive result from treatment is usually found within a week after the start of treatment.

Since the drug contains bile acids and has a choleretic effect, it can be used if tenesmus is associated with constipation or pancreatitis.

During treatment with Allochol, one should not forget about the need to normalize nutrition: the patient is assigned a diet and an individual meal regimen is determined.

Herbal treatment

Medicinal plants for the digestive tract and bladder can significantly relieve pain and tenesmus in the case of many diseases, and also serve as the prevention of pathologies such as ulcers, enterocolitis, cystitis, etc.

It is important to understand that the positive effect of herbal medicine is observed only with the correct prescription of certain herbal preparations, which are taken only under the supervision of a doctor.

The simplest recipes for decoctions or infusions are considered the most popular, as they are affordable and easy to prepare. As a rule, decoctions are made on the basis of the bark and rhizomes of plants, and infusions are made on the basis of inflorescences, foliage and soft shoots.

To prepare the infusion, the necessary proportions of plants and water brought to a boil are collected in advance. The raw materials are poured with water and kept under a lid for about 45-60 minutes. Next, the agent is filtered and taken according to the recipe.

The broth is cooked longer: the raw material is poured with hot water and kept on low heat for 10-20 minutes, then removed from heat and insisted for another 10 minutes.

The proportions given below are indicated as 1 tbsp. L. Vegetable mixture per 200 ml of boiling water.

For tenesmus, you can use the following mixtures of herbs:

• Calamus root, three-leafed watch, wormwood, caraway seeds (in equal shares). The infusion is taken in 1 tbsp. L. Half an hour before meals.
• Dandelion root, wormwood, yarrow herb (20:60:20). The infusion is taken in 1 tbsp. L. 15-20 minutes before meals.
• Heather, St. John's wort, centaury, buckthorn bark, mint leaves (25: 25: 20: 15: 15). The infusion is taken 50 ml up to 4 times a day between meals.
• Centaury, mint leaves (20:80). The infusion is taken in 100-150 ml of trida per day for half an hour before meals.
• St. John's wort, centaury herb, mint leaves, chamomile flowers, dried chum (in equal shares). The infusion is taken 50 ml up to 4 times a day between meals.
• Three-leafed watch leaves, St. John's wort herb, mint leaves, yarrow, dill seeds (25: 30: 15: 15: 15). An infusion is prepared, which is taken in 50 ml 4 times a day.

If after taking the herbal remedy the condition does not improve or even worsens, you should definitely consult your doctor.

Prevention

Prevention of tenesmus, as clinical manifestations of digestive or urinary pathologies, consists in preventing the influence of negative factors and background diseases. Preventive methods consist of the following steps:

• eradication of bad habits;
• regular physical activity;
• drawing up a balanced regime of work and rest;
• good quality food;
• control of own weight, prevention of obesity;
• annual preventive examinations.

The quality of nutrition is of great importance in the prevention of tenesmus. Nutritionists advise to observe the following food rules:

• to reduce, or better - to exclude the use of alcoholic beverages (it is permissible to drink no more than 150 ml of light alcohol per week in order to prevent damage to the mucous membrane of internal organs);
• exclude the use of "soda";
• forget about snacks "on the run" and "dry water", chew food well;
• to minimize the amount of fried foods in the diet, as well as smoked meats, pickles, marinades, preservatives;
• carefully read the composition of dishes and products, avoid food with chemical dyes, preservatives, synthetic flavors and aromatic additives;
• eat more plant foods, whole grains;
• prepare meals using vegetable oils, not animals;
• avoid eating foods that are too hot or too cold (optimally warm, with a temperature of about 40 ° C);
• establish a drinking regime, consuming about 1.5 liters of clean water daily;
• do not overeat, eat little by little every 2-3 hours;
• try to eat at the same time every day;
• timely treat diseases of the teeth and gums.

There is no need to treat nutrition with disdain: high-quality products and adherence to the diet is a kind of preventive basis for human digestive and urological health.

Stress has a significant impact on the functionality of the gastrointestinal tract and bladder. Therefore, it is important to learn how to avoid conflicts, or, as they say, "save your nerves." Sometimes meditation practices, auto-training, consultations of a psychotherapist come to the rescue. Such methods also increase stress resistance:

• high-quality nutrition with sufficient intake of vitamin D;
• ultraviolet and air baths;
• physical activity, swimming, aerobics, pilates;
• trainings in psychology, acquisition of introspection skills.

In addition, it is important to consider that the overwhelming majority of drugs have side effects. Therefore, it is not recommended to practice self-medication, as well as independently adjust and prolong the doctor's prescriptions.

For example, one of the factors in the appearance of tenesmus - dysbiosis - is the result of uncontrolled antibiotic therapy, taking laxatives or enterosorbent drugs. And non-steroidal anti-inflammatory drugs (in particular, acetylsalicylic acid) negatively affect the mucous membrane of the digestive tract.

Taking care of your own health and following simple recommendations will help prevent the appearance of tenesmus, as well as other serious pathologies.

Forecast

Depending on the initial pathology, tenesmus often acquires a complicated course, which negatively affects the duration of the disease and significantly worsens the prognosis, increasing the risks of developing adverse consequences. The likelihood of complications is increased in the environment of patients receiving inadequate and ineffective initial treatment, or not receiving therapy at all. [20]

The basic mechanism for preventing a complicated course of the disease, in which tenesmus is noted, is the use of an integrated therapeutic approach. Treatment should include enterosorbents, rehydration medications, probiotics, and, if indicated, antibiotics or antiviral medications. In the absence of effectiveness, the treatment regimen is urgently reviewed and corrected, constantly monitoring the condition of the patient who is in stationary conditions.