Tenesmus a term use to describe a complaint of pain in the anus while defecating.Pain can be due to trauma such as tear, puncture wound , inflammation on the mucosal surfaces or structure underneath. The cause of trauma can be due to hard stool get stuck on the way out or some hard object [ penis, dildo etc] inserted into the rectum.
A doctor would ask history including diet taken ,psychological problem, and sexual history of the patient when dealing this type of cases. On examination, doctor would have examine
1.if patient is in distress, due to pain or emotionally.
2.presence of hard stool in the left side of the abdomen.
3.any sign of injury,wound,tear, change of color, bruises,swelling,hardness,imbalance contour,pus discharge and pain on palpation.
4.any visible sign of trauma in the inside, visualized using proctoscope, magnifying glass. Bruises, scratch marked on any other site of the body could be seen if the victim, or attacker have to fight for it.
5.swab usually taken for culture and sensitivity. the normal flora found in the anus is e-coli, but with the presence of other organism could be due to infection.
6.in criminal case, the examining doctor should take any sample DNA possible from the anal region to look out DNA of assailant. the doctor also should look out for jelly, semen, blood , pubic hair, saliva or even massaging oil.
7.anus which is normal, not traumatized would give a good grip to the examining finger.while patient would jump ,cry, or even shout due to pain if recently get penetrated.
8.other clinical sign of pain will be remarkable such as raised heart rate, raised blood pressure, sweating, blush,and raised respiratory rate.
9.homosexual patient , patient with past history of anal surgery,usually had poor grip anus [loosen up], may have stool incontinence.
10.patient with chronic disease,sexual transmitted disease may have sign and symptom of the disease at the same time.
11.doctors usually would observe the way the patient walk in into the consultation room, and walk out;if he had pain at the anal region, buttock, or even the thigh, the gait will be odd,limping, dragging his leg, or at least walk slowly.
12.those who get pain at the buttock, may sit at the edge of the chair, to avoid pressure on the painful site.