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Tenesmus 961

• Plasma and whole blood taurine levels should PEARLS & CONSIDERATIONS potential problems may be identified and
be re-evaluated in 1-2 months. Comments corrected before clinically significant disease
VetBooks.ir to monitor resolution of heart disease • Echocardiographic improvement may require Client Education Diseases and Disorders
develops.
• Radiography, echocardiography as needed
3-4 months of supplementation.
PROGNOSIS & OUTCOME
• A recently identified association between
properly formulated diet.
grain-free diets and dilated cardiomyopathy Explain the importance of feeding pets a
• Clinical improvement (improved energy, has not been confirmed to be entirely due
appetite) is often noted after a few weeks to taurine deficiency. SUGGESTED READING
of supplementation before echocardiographic Sanderson SL: Taurine and carnitine in canine
improvement. Prevention cardiomyopathy. Vet Clin North Am Small Anim
• Early treatment can be curative, but chronic Feeding a properly formulated diet Pract 36:1325-1343, 2006.
disease may allow for extensive, permanent AUTHOR: Sherry Lynn Sanderson, DVM, PhD,
change in the myocardium. Technician Tips DACVIM, DACVN
• Blindness is irreversible. A diet history should be collected for every EDITOR: Jennifer Larsen, DVM, PhD, DACVN
patient at every visit. Risk factors for many

Tenesmus Client Education
Sheet

BASIC INFORMATION ○ Assess fecal consistency • Causes of tenesmus are detailed on p. 1285.
○ Palpate urethra ventrally: assess size/shape/ ○ Rectal disease (e.g., colitis, constipation,
Definition texture/presence of mass, urethrolith, or other obstruction)
Ineffectual or painful straining to eliminate stricture ○ Anal, perianal, perineal disorders (e.g.,
wastes; generally applies to straining to defecate, ○ Palpate anal sacs (mass/impaction/ proctitis, perianal fistula, anal stricture,
most often due to obstruction or inflammatory infection/abscess/rupture). Express anal anal sac disorders)
lesions of distal colon, rectum, or anus sacs if full and re-palpate for presence of ○ Pelvic disorders (e.g., mass, misaligned
a mass. healed fracture)
Epidemiology • Examine bladder size and vulva/vagina or ○ Lumbosacral disease
SPECIES, AGE, SEX prepuce/penis to identify genitourinary ○ Prostatomegaly
Dogs and cats, any age, either sex causes of straining (misinterpreted as strain-
ing to defecate). Initial Database
ASSOCIATED DISORDERS • Observe the animal defecating/urinating
• Rectal prolapse (greater incidence in puppies, Etiology and Pathophysiology ○ Position of tail: low carriage/resentment
kittens) • Colonic, rectal, or anal inflammation trig- of tail elevation suggests sacrocaudal
• Megacolon (if chronic constipation/ gers an afferent impulse in parasympathetic discomfort.
obstipation) pathways through the pelvic nerve, sacral ○ Posture: arched back suggests abdominal,
spinal cord, and cerebral cortex. back, or joint pain.
Clinical Presentation • The resultant efferent signal is carried by ○ Presence/absence of gross fecal abnormali-
HISTORY, CHIEF COMPLAINT parasympathetic efferent nerve fibers in ties (e.g., diarrhea, hematochezia)
• Frequent posturing to defecate/urinate the pudendal nerve, leading to stimulation • Neurologic exam (p. 1136): perineal reflex,
without producing feces/urine of the colon, rectum, anus, and pelvic anal/perineal tone, lumbosacral/back pain
• Excessive licking/chewing of perineal region muscles. • CBC, serum biochemical profile, urinalysis,
• Vocalizing when posturing (cats > dogs) • Intraabdominal pressure is increased by fecal flotation: elucidate possible urinary or
• Inappropriate defecation or refusal to defecate posturing, contraction of the diaphragm systemic abnormalities, or parasites
(severe pain/constipation) and abdominal muscles, and closing of the • Radiographs (abdominal/pelvic): distended
• Common error in cats is overassumption glottis. colon, pelvic narrowing, sublumbar lymph-
of constipation, whereas careful history/ adenomegaly, mass effect, enlarged prostate
observation might reveal lower urinary tract DIAGNOSIS
signs (i.e., stranguria [p. 802]). Advanced or Confirmatory Testing
Diagnostic Overview • Abdominal ultrasonography: gastrointestinal
PHYSICAL EXAM FINDINGS • Tenesmus is a clinical sign, not a disease; (GI)/pelvic mass ± lymphadenopathy, uro-
• Examine anus/perianal area: erythema of successful management requires identification genital tract, GI motility, distention/wall
anal/perineal region, porphyrin-stained of the underlying cause. thickening
fur, altered skin pigmentation (suggesting • Diagnostic test selection is highly dependent • Colonoscopy: rigid and/or flexible to identify
excessive licking/chewing), perineal fistulas/ on obtaining a clear history, observing the and biopsy polyps, masses, strictures, or
masses, pseudocoprostasis (anal obstruction animal urinating and defecating, and per- infiltrative lesions; facilitate biopsy
due to severe matting of fur with feces) forming a thorough exam (rectum, perineal, • Intrarectal ultrasonography: specific probes
• Abdominal palpation: mass, signs of discom- and perianal areas). Some diagnoses (e.g., required
fort, organomegaly, stool in colon perianal fistulas) may not require additional
• Rectal palpation (with sedation/general testing. TREATMENT
anesthesia if painful)
○ Rule out perineal hernia, mass, prostato- Differential Diagnosis Treatment Overview
megaly, pelvic fractures, stricture, foreign • Genitourinary tract disorders, especially in The goals of treatment are to address the
body cats, may mimic straining to defecate. underlying cause and relieve patient discomfort.
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