How to Reduce Symptoms of Incomplete Bowel Movements (2024)

An incomplete bowel movement—the feeling that you still have to poop, even when you don't—can be uncomfortable and frustrating.

Also known as incomplete evacuation, it is a hallmark of irritable bowel syndrome (IBS). It can also be caused by chronic constipation, pelvic floor disorders, and infections. Fortunately, there are ways to deal with this aggravating and surprisingly common symptom.

This article explains why incomplete evacuation occurs and outlines the various pharmaceutical, self-care, and psychotherapy treatment options.

What Is Incomplete Evacuation?

Incomplete evacuation is the sensation that a bowel movement has not been completed even if it has. This is not an uncommon symptom affecting people with chronic (frequent or persistent) constipation or chronic diarrhea.

When you're chronically constipated, thepassage of small, hard stools can make the rectum, anus, and colon extra sensitive. The same can occur with chronic diarrhea, particularly when you are straining. There may also be uncontrollable clenching sensations that can occur even when no stools are present.

There are two mechanisms that are thought to underpin incomplete evacuation in people with constipation-predominant IBS (IBS-C) and diarrhea-predominant IBS (IBS-D):

• Visceral hypersensitivity refers to a heightened pain sensitivity within internal organs—in this case, the large intestine, the rectum, and the anus.
• Motility dysfunction occurs when the muscles of the digestive tract aren't operating normally, which interferes with your ability to pass a comfortable, well-formed stool.

Straining during bowel movements can also lead to hemorrhoids, which can also cause tenderness and a feeling that "something is up there" in the rectum.

What Causes Incomplete Evacuation?

Incomplete bowel evacuation is often associated with constipation, but it can be caused by other common and not-so-common conditions.

Possible causes of incomplete evacuation include:

• Chronic constipation
• Colorectal cancer
• Diverticular disease
• Infection in the colon
• Inflammation of the colon or rectum
• Inflammatory bowel diseases, like Crohn’s and ulcerative colitis
• Irritable bowel syndrome
• Motility disorders
• Pelvic floor dyssynergia
• Prolapsed hemorrhoid
  

How to Empty Bowels Completely—No Matter the Cause

Whether you're affected by diarrhea or constipation, there are some universal strategies that can help you empty your bowels completely:

• Stay hydrated: Aim to drink at least 64 ounces of water a day to provide ample hydration to the digestive tract and keep things moving.
• Keep active: Moving your body helps to stimulate the transport of waste through your intestines.
• Eat more produce: Fruits and vegetables have plenty of fiber that can help keep your bowels moving.
• Elevate your feet: Posture-changing devices, like a footstool, creates an easier pathway to evacuate poop.
• Try an enema: Enemas involve injecting fluid into the colon to loosen impacted stool and clear out any remaining waste products.

When these aren't enough, additional treatments may be recommended depending on what condition you have.

Incomplete Evacuation With Constipation

If you have constipation, the sensation of incomplete evacuation may be accurate. Due to the difficulty in passing stool, it is likely that you have not fully emptied the rectum, leaving you with feelings of dissatisfaction and discomfort.

To counteract this effect, your healthcare provider may prescribe medication to help the intestines pass stool along. You may also benefit from simple self-care strategies that can be tried at home or other forms of therapy that relieve symptoms by targeting the gut-brain connection.

Prescription Medications

The Food and Drug Administration (FDA) has approved two medications for treating IBS-C: Linzess (linaclotide) and Trulance (plecanatide). Both drugs are classified as guanylate cyclase activators, which target receptors in the intestines. That prompts an increase in the intestinal fluid which:

• Keeps the stool softer
• Helps reduce abdominal pain
• Helps reduce stool frequency
• Alleviates IBS symptoms

These drugs are considered safe and well-tolerated, with the most common side effect being mild to moderate diarrhea.

Although they are not approved specifically to treat IBS, tricyclic antidepressants are known to have a therapeutic effect on the gastrointestinal system. For this reason, healthcare providers may prescribe them off-label to treat IBS symptoms such as abdominal pain.

Tricyclic antidepressants help maintain serotonin levels in the gut, which reduces inflammation and promotes gut motility. Motility refers to the movement of food and stool through the intestines.

Commonly prescribed tricyclic medications include:

• Elavil (amitriptyline)
• Tofranil (imipramine)
• Norpramin (desipramine)
• Aventyl (nortriptyline)

Both of these approaches are recommended by the American College of Gastroenterology's (ACG) clinical guidelines for the management of IBS, which were published in January 2021. Linzess and Trulance are recommended specifically for IBS-C, while tricyclics are recommended for all IBS subtypes.

Self-Care Strategies

You can also try several self-care strategies at home to relieve the feeling of incomplete evacuation when you have IBS-C.

• Bowel retraining: Many people have bowel movements in the morning and not so much at night. Pay attention to your own biorhythm and try to schedule a trip to the toilet around that same time each day.
• Visualization: Allow your body the time to empty as much stool as possible, envisioning an empty rectum as you evaluate the "completeness" of the movement.
• Soluble fiber intake: Slowly increase your intake of foods that are rich in soluble fibers (but not insoluble fiber), or try a psyllium-based fiber supplement. Foods high in soluble fiber include bananas, blueberries, kiwi, oranges, carrots, eggplant, green beans, oatmeal, zucchini, and potatoes with skin.

The ACG guidelines specifically state that insoluble fiber, in studies, has not been shown to improve IBS symptoms, while soluble fiber has. Insoluble fiber is found in foods like wheat bran and vegetables.

Adequate fiber intake is defined as 25 grams for adult women and 38 grams for adult men. If you're having trouble eating enough soluble fiber in your diet, consider including a fiber supplement to boost your intake.

Gut-Directed Psychotherapy

Dyssynergic defecation is a problem with the function of the nerves and muscles used to pass stool. If you believe you have this problem, you may want to look into biofeedbackor physical therapy as a way to ease your symptoms.

Gut-directed psychotherapy is recommended by the ACG guidelines, as it's been increasingly viewed as an effective complementary therapy for IBS.

The goal of gut-directed psychotherapy is to reduce gastrointestinal symptoms through coping strategies.

In particular, cognitive behavioral therapy (CBT) can teach muscle relaxation and breathing techniques to lower pain sensitivity and encourage the mind to better regulate gut motility.

Incomplete Evacuation With Diarrhea

The sensation of incomplete evacuation for people who experience chronic diarrhea is much more complex.

Although it's known by the blanket term tenesmus, there's a lack of research as to what causes this phenomenon when it occurswithout any obvious physiological reason.

Fortunately, effective therapies are available to aid with symptoms.

Prescription Medication

Xifaxan (rifaximin) is an FDA-approved antibiotic for treating IBS with diarrhea (IBS-D), and this treatment is backed by the ACG guidelines, as well.

Xifaxan stays active in your gastrointestinal tract but is not absorbed⁠—a factor that contributes to its safety profile, as it's not likely to interact with other medications or become less effective over time. Side effects with rifaximin are mild and uncommon but can include:

• Diarrhea
• Loss of taste
• Anorexia
• Nausea
• Nasal irritation

Self-Care Strategies

If you pass stool that is loose and watery, it's likely that any firm stool that was in the colon has already passed. Yet, nerve and muscle dysfunction can make it feel like you still need to empty your bowel.

In order to counteract this sense of urgency, it helps to remind yourself that no further stool really needs to come out.

Keep in mind that there is no such thing as a truly empty bowel, as new stool is constantly being produced. In terms of the fear of future diarrhea episodes, remember that it is easier for the muscles of the anus to contain stool that is firm than watery stool that isn't ready to pass yet.

If you feel a constant urge to run to the toilet, try to delay yourself. Sit quietly in a spot near the bathroom and see if you can use relaxation exercises to calm your body until the sense of urgency passes without having to make another trip to the bathroom.

Calming your body will also help to reduce any anxiety that might be causing the nervous system to continue to send out signals for further (unnecessary) emptying.

As with IBS-C, gut-directed psychotherapy such as CBT is recommended as a complementary therapy that improves IBS symptoms and the distress that can accompany them.

Summary

Incomplete evacuation, the sensation that a bowel movement is not complete, is common in people with chronic constipation and chronic diarrhea, particularly those with irritable bowel syndrome (IBS).

In people with constipation-predominant IBS (IBS-C), treatment options include a high-fiber diet, bowel retraining, gut-directed psychotherapy, and pharmaceutical drugs like Trulance and Linzess.

In people with diarrhea-predominant IBS (IBS-D), options include bowel retraining, gut-directed psychotherapy, and the antibiotic Xifaxan.