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Incomplete Evacuation of Stool

Certain GI problems can make you feel like you have stool left inside (called tenesmus) like irritable bowel syndrome, colitis, and even constipation. Talk to your doctor about treatments if you have these symptoms.
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Written by
Adam Pont, MD, PhD.
Gastroenterology Fellow, New York Presbyterian Hospital/Columbia
Last updated September 23, 2021

Constipation questionnaire

Answer our clinicians' questions to get a constipation treatment prescription for $25 and know if your constipation is serious.

Constipation questionnaire

Answer our clinicians' questions to get a constipation treatment prescription for $25 and know if your constipation is serious.

See constipation treatment options

Only available in: CA, NY, TX, FL, IL, NC, PA, OH, MI, and WA

What is incomplete evacuation of stool?

It’s not uncommon to have a bowel movement, yet have the sensation that everything did not come out. When this feeling occurs regularly, it’s called tenesmus.

With tenesmus, stool isn’t actually left behind in your intestine. It just feels that way. It usually means that something is affecting your rectum (the part of the colon by your anus). Causes of tenesmus include irritable bowel syndrome or ulcerative colitis.

In some cases, you may actually have stool left behind (incomplete evacuation of stool). This happens when your anal and pelvic muscles do not coordinate well to allow stool to exit your body.

Treatment of tenesmus or incomplete evacuation of stool depends on the underlying cause.

Pro Tip

Most of the time, the feeling of incomplete evacuation is just that—a feeling. It is less likely that stool is actually remaining that hasn’t been expelled. —Dr. Adam Pont

Causes

1. Irritable bowel syndrome

Symptoms

  • Belly pain more than once a week, often related to bowel movements.
  • Diarrhea, constipation, or a mix of both.
  • Stool becomes frequent (more than 3 times a day) or less frequent (less than 3 times a week).
  • Feeling like there is stool remaining, even after straining to have a bowel movement.

Irritable bowel syndrome (IBS) is a common, chronic disorder of the large intestine that causes changes in your bowel movements and abdominal pain.

There are subtypes of IBS: You can have primarily diarrhea, primarily constipation, or both. All forms cause abdominal pain at least once a week. IBS is more common in women, people under 50, and people with mental health issues (particularly depression and anxiety.)

IBS is a chronic disease, meaning that symptoms last for months or years. Symptoms usually come and go over time. Stress often worsens symptoms.

Treatment can involve several different approaches. You may need to change your diet if any foods or drinks trigger your symptoms. Your doctor may recommend fiber supplements, regular exercise, and ways to manage life stressors (including getting enough sleep). There are also several prescription medications that can help with your symptoms.

Constipation questionnaire

Answer our clinicians' questions to get a constipation treatment prescription for $25 and know if your constipation is serious.

See constipation treatment options

Only available in: CA, NY, TX, FL, IL, NC, PA, OH, MI, and WA

2. Constipation from functional outlet obstruction

Symptoms

  • Trouble pushing stool out of the anus
  • Trouble starting or finishing a poop
  • A feeling that you did not get all your stool out after a bowel movement (incomplete evacuation)
  • Less than three bowel movements a week

Constipation is when you have trouble passing stool. One type of constipation involves difficulty pushing the stool out. Your pelvic muscles have trouble coordinating the muscles movements, resulting in a functional outlet obstruction. This is also called dyssynergic defecation or pelvic floor dyssynergia.

You will be referred to a gastroenterologist (digestive disease specialist) who can diagnose you. They will use a special probe (manometry) or inflated balloon to measure your ability to push out stool.

Treatment of constipation from functional outlet obstruction involves biofeedback training. Your doctor will send you to a special type of therapist who will use techniques to teach your pelvic muscles to work together to have a bowel movement. They may also have you stick to a specific schedule to try having bowel movements—called “habit training”.

3. Ulcerative colitis

Symptoms

  • Crampy abdominal pain
  • Frequent bloody diarrhea—may wake you up at night
  • Urgent need to have bowel movements, often with very little warning
  • Feeling that you still need to pass stool, even after you have had a bowel movement
  • Fever
  • Weight loss

Ulcerative colitis (UC) is a form of inflammatory bowel disease (IBD). The lining of your large intestine (colon) and rectum become inflamed and develop tiny, open sores, called ulcers. UC is caused by abnormal immune system activity primarily in your large intestine. Diagnosis is usually done by a colonoscopy and a biopsy of the intestinal wall.

UC is chronic and develops over time. It has episodes of severe symptoms or “flares.” Sometimes with severe rectal inflammation, you can get a sensation that you need to pass stool, even after you just had a bowel movement (tenesmus).

There are many treatment options, including pills and medications that are injected (through an IV or under your skin.) You may also use suppository creams or sprays.

Although there is no cure, the goal of treatment is to cause it to go into “remission”, meaning you don’t have symptoms and the intestinal lining can heal. If medications are not successful in inducing remission, you may require surgery to remove your large intestine.

UC increases your risk for colon cancer, and it is important that you are treated and followed up by a gastroenterologist.

Other possible causes

Several other conditions may also cause a sensation of incomplete evacuation of stool, though these are either much less common or the sensation is not usually a main symptom. They include hemorrhoids, cancer, certain GI infections, and Crohn's disease.

Constipation questionnaire

Answer our clinicians' questions to get a constipation treatment prescription for $25 and know if your constipation is serious.

See constipation treatment options

Only available in: CA, NY, TX, FL, IL, NC, PA, OH, MI, and WA

When to call the doctor

If you have a persistent feeling of incomplete evacuation, call your doctor. This could be a sign of a more serious condition like IBD or colon cancer. Depending on your symptoms, they may refer you to a gastroenterologist for further testing.

Incomplete evacuation of stool will almost never require a trip to the ER.

Pro Tip

Ask your doctor: How long do I need to take the prescribed treatment before I begin to feel improvement in my symptoms? —Dr. Pont

Treatments

At-home care

Though treatments often depend on the cause, some approaches that may help alleviate your symptoms include:

  • Fiber supplements
  • Laxatives
  • Over-the-counter pain medications for the abdominal pain and cramping

Other treatment options

If your incomplete evacuation of stool is caused by an underlying condition, your doctor may prescribe different medications. Options include:

  • For IBS: medications with laxative effect such as linaclotide (Linzess).
  • For UC: steroids (oral or intravenous), immunosuppressants such as azathioprine (a pill), biologic medications such as infliximab (Remicade, given intravenously), or medications delivered rectally like mesalamine enema (Rowasa).

Dr. Rx

Biofeedback training for dyssynergic defecation is an interesting process. A trained therapist will use a combination of visualization, feedback, and rectal device probes to train your anal and pelvic muscles to coordinate correctly to have effective bowel movements. Biofeedback training programs are often run by Colorectal surgery practices. —Dr. Pont

Hear what 3 others are saying
Incomplete evaculationPosted June 29, 2021 by S.
I have been feeling incomplete evacuation for a long time, almost 10 years. I am 47 now. Many times I approached gastro Dr. They called it rectal relapse, but I don't have constipation or abdominal cramps. I have to go 2 to 3 times a day and often I need to go just after any intake. Meals especially. I feel rectal outgoings. It causes the rectal hole to reduce or to close so the remaining stool is stopped and it becomes more smelly until the next time I go. I also suffer from a smell from my mouth, even with proper brushing. The dentist declared my teeth OK, but my mouth feels stale and smells bad breathy. No blood, no constipation, no cramps, no diarrhea. Have routine intake, no loss of weight or hunger.
How to have complete evacuation??Posted April 28, 2021 by T.
I have incomplete bowel movements. I have some sort of IBS. No Crohns’ diseases, no infection, no bloody bits, no ulcerative conditions. I have food sensitivities, lactose and gluten. If I have diarrhea, it’s usually associated with a flu-type bug or bad food. I can have complete bowel evacuation, but I can also have multiple bowel movements in an hour. I can also have Milk Dud poops.
Why can't my poop come outPosted March 31, 2021 by D.
I have such a hard time being able to empty my stomach. When I try to have a bowel movement it feels like it is fixing to come out but then all of a sudden it is like a door shuts and blocks it. When this happens it makes me feel like all my waist is pressing against my rectum but will not come out no matter what I do and it is very painful. Can anybody direct me in the right direction to find out what in the world is going on? If I have one bowel movement a week, that is rare. I have gone up to 10 days without a bowel movement. I feel like I am walking around in a diaper full of poop at 62 years old.
Gastroenterology Fellow, New York Presbyterian Hospital/Columbia
Dr. Pont is currently a fellow in Gastroenterology at New York Presbyterian Hospital/Columbia, where he also completed his residency in Internal Medicine. Dr. Pont received his medical degree and PhD at the New York University School of Medicine. He earned his BS in Biological Systems Engineering at the University of Nebraska-Lincoln.

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