Tenesmus in UC: Why You Feel Like You Still Have to Go (Even When You Don’t)
Last Updated Jan 15, 2026
Tenesmus can feel confusing and exhausting, especially when ulcerative colitis (UC) has already made bathroom habits unpredictable. In plain terms, tenesmus is the feeling that a bowel movement still needs to happen, even after the rectum seems empty. Some people describe it as a constant urge to poop in UC, or the sense of “not being done” after going. Knowing what this symptom means, and what it may be signaling, can make it easier to explain to a care team and to track over time.
Tenesmus meaning, and why it happens in ulcerative colitis
Tenesmus (pronounced “teh-NEZ-muss”) is a persistent urge to pass stool even when little or nothing comes out. It may come with pressure, cramping, rectal pain, or straining. One reason it can happen is inflammation that irritates the nerves and tissues involved in bowel movements, so the body keeps sending “time to go” signals even when the rectum is already empty. Tenesmus is considered a symptom that deserves medical attention, especially if it is new or paired with concerning signs like fever, severe pain, or blood in stool. [1]
In UC, inflammation starts in the large intestine and involves the rectum. That location matters because rectal inflammation in UC can strongly affect urgency and sensation. In fact, major gastroenterology guidance lists tenesmus as a possible UC symptom, along with diarrhea and blood in stool, and notes that symptoms vary based on how much of the colon is inflamed and how severe the inflammation is. [2]
Tenesmus is also closely tied to proctitis (inflammation of the rectum). Proctitis symptoms often include rectal pain, bleeding, mucus, diarrhea, and a frequent or continuous feeling that stool needs to pass. Proctitis is common in people with inflammatory bowel disease (which includes UC). [3]
What tends to help, and when it can signal worsening inflammation
Because tenesmus is a symptom, what helps often depends on the “why.” In UC, tenesmus may improve when the underlying inflammation improves. When inflammation is mainly in the rectum or lower colon, symptoms can look a little different than classic watery diarrhea. For example, clinical descriptions note that when ulceration is limited to the rectosigmoid area, stool may be normal or even hard and dry, but mucus and blood discharge can occur, and when disease is more extensive, frequent bowel movements with distressing rectal tenesmus can occur (sometimes with blood and pus). [4]
Tenesmus can also overlap with urgency UC, the sudden need to get to a bathroom quickly. Patient education from a leading advocacy organization describes bowel urgency as one of the most bothersome inflammatory bowel disease symptoms, and reports that severe urgency is a strong predictor of disease activity, which is one reason it is important to share these symptoms with the healthcare team. [5]
In day-to-day life, many people find it useful to track patterns that can help a clinician understand whether tenesmus seems linked to inflammation (for example, bleeding, mucus, nighttime symptoms, or rising stool frequency) or whether other factors might be contributing (such as constipation, anal irritation, or pelvic floor muscle tension). Getting prompt medical input is especially important if tenesmus is worsening, is newly severe, or comes with signs of significant illness (such as fever, severe abdominal pain, or heavy bleeding). This article is educational and not a substitute for individualized medical care.