Tenesmus

Description:

Tenesmus – the clinical symptom which is characterized by extremely painful and ineffectual desires on an urination or defecation.

      At the same time directly the urination or defecation do not occur or are extremely unproductive. This term came from the Greek word teinesmos that means a vain desire.

      Allocate two types of tenezm: tenesmus on an urination (the Greek term - teinesmos urinae) and tenesmus on defecation (the Greek designation - teinesmos alvi).

      Development of a clinical picture, similar to tenesmus, but not followed expressed morbidity received the name a false desire.

Symptoms Tenezmov:

Emergence of painful feelings in the bottom of a stomach, persistent desires on an urination or defecation is characteristic of a clinical picture of a disease. The patient feels enterospasms, a front abdominal wall. Desires are not productive, perhaps, allocation of contents of intestines or urine in small volumes.

      Character of separated can be mucous, purulent or hemorrhagic that is defined by the nature of the pathological process which caused a disease. At intestines tenesmus the crick of outside and internal proctal sphincters is practically always noted. At tenesmus on defecation development of erosive damages of skin, maceration, cracks in a zone around an anus is possible.
      Intensity of symptoms can fluctuate from small discomfort to intolerable.

Reasons Tenezmov:

Development of tenezm is most often observed at various diseases of a large intestine, to be exact a direct and/or sigmoid gut. Tenesmus can be caused by new growths of a large intestine, hemorrhoids, rectum cracks, polyps, a proctitis, a paraproctitis, a sigmoiditis, a prolapse of the rectum, fistulas and intestinal stenoses, a disease Krone, a syndrome of the angry intestines.

      It is possible to carry to the reasons of tenezm also various infectious diseases of intestines. So tenesmus develop at dysentery, intestines tuberculosis, a salmonellosis, cholera, typhus, an intestinal amebiasis, etc.

      Tenesmus are in turn provoked to an urination by pathology of an urinary system: prostatitis, prostate adenoma, stones of a bladder and ureter. Development of tenezm after operative measures on a small basin, for example, after a prostatectomy is possible.


      Tenesmus of both types can have the psychosomatic nature, developing at neurosises and other boundary frustration. They can be connected with tumors of a small pelvis, gynecologic pathology, diseases of the central and peripheral nervous system (for example, at diseases of a spinal cord, a myelitis).

      In cases when the exact reason of tenezm does not manage to be established, speak about idiopathic tenesmus or an idiopathic proctospasm.

      In a disease pathogeny the leading role belongs to disturbance of excitability of an autonomous nervous system. Spasms of smooth muscles of a large intestine and bladder are the cornerstone of the mechanism of development of tenezm. In development of tenezm on defecation spastic reductions of sigmoid and direct muscles have the greatest value. Then muscles of a front abdominal wall, a small pelvis and a crotch are involved in process. Reductions of smooth muscles have unproductive character and do not lead to advance of contents of intestines or bladder and do not promote their emptying. It is connected with the chaotic, not coordinated nature of reductions that complicates creation of a normal wave of a vermicular movement.

Treatment Tenezmov:

  In view of the fact that tenesmus can be manifestations of a number of diseases including malignant, performing only symptomatic therapy, without establishment of the exact reason of pathology, is not recommended. The main therapy has to be directed to treatment of a basic disease.

      Use of myotropic spasmolysants Drug of the choice is the cornerstone of symptomatic therapy Nospanum (Drotaverinum) is. Drug is appointed in the form of tablets on 40 and 80 milligrams to three times a day. At the expressed clinical picture drug is appointed parenterally on 1 ampoule (an ampoule – 2 milliliters, concentration of 20 milligrams to 1 milliliter) - once. Long use of drugs given groups can cause dizziness, arrhythmia, feeling of heat in all body. Decrease in speed of reactions and an incoordination is possible.

      Intensity of a clinical picture, as a rule, decreases after acceptance of cool sedentary trays. At tenesmus on defecation carrying out microclysters with broth of a camomile or weak solution of potassium permanganate is possible.