Sensation of incomplete post-defecatory evacuation

Specialty: Gastrointestinal.

• Secondary rectal tenesmus
• defecatory dissatisfaction
• persistence of the need to defecate

Why it occurs

• Irritable bowel syndrome with altered rectal visceral sensitivity (hypersensitivity to rectal stretching)
• Previous or posterior rectocele causing retention of a fragment of the fecal bolus
• Internal rectal mucosal prolapse that simulates the presence of feces by pressing the mechanoreceptors of the anal canal
• Grade II-III prolapsed internal hemorrhoids that distend the distal rectal ampulla
• Active ulcerative colitis with inflammation of the rectal mucosa (ulcerative proctitis).

Initial workup

Careful rectal examination (to rule out masses, fecalomas or internal prolapses) | Complete colonoscopy or rectosigmoidoscopy (essential to rule out rectal inflammatory or neoplastic pathology) | Anorectal manometry and MR defecography.

Standard management

• Osmotic laxatives — polyethylene glycol 17 g per day to maintain soft stools that require less effort and are evacuated completely
• Corticosteroids or topical anti-inflammatories in case of confirmed proctitis — mesalazine suppositories or foam 1 g/day or hydrocortisone suppositories
• Visceral sensitivity modulators (amitriptyline 10-25 mg at night if associated with irritable bowel syndrome).