Feeling you have not fully emptied your bowels: causes and when to get it checked

Feeling that you have not finished after a bowel movement is one of the most commonly reported bowel symptoms. In most people it reflects constipation, piles or irritable bowel syndrome, all of which are treatable. It can also be due to how the muscles at the end of the bowel and in the pelvic floor work together.

It deserves more attention when it is new, when it persists for weeks, or when it comes with other changes such as blood in the poo, looser or more frequent stools, weight loss, tiredness or a lump. Cancer Research UK and the NHS both list a feeling of needing to poo even after you have just been as one of several possible symptoms of bowel cancer, which is why the overall picture matters.

The NHS defines constipation as changes to how you poo, including not pooing as often or finding it hard to poo. It says it is likely to be constipation if you have not had a poo at least 3 times in the last week, the poo is unusually large or small and dry, hard or lumpy, you are straining or in pain, or you feel like you have not fully emptied your bowels.

Guts UK lists the main symptoms in similar terms and adds needing to use manual manoeuvres to empty the bowel, such as pressing on the pelvic floor area or inserting a finger. It says that symptoms are more likely to indicate constipation the more of them you have, and that constipation is bothersome but usually not serious.

The NHS advice includes more fibre, plenty of fluids, regular activity, a regular toilet routine without ignoring the urge, resting your feet on a low stool, and a pharmacist-recommended laxative if lifestyle changes do not help. Long-term constipation can lead to faecal impaction, where poo has built up in the rectum and the main symptom is diarrhoea leaking around the blockage, which needs treatment from a clinician.

Guts UK explains that there are three main mechanisms of constipation: slow movement of contents through the bowel, normal transit with symptoms, and a defaecatory disorder in which a person has difficulty evacuating the bowel despite excessive straining because of a problem with muscles lining the pelvic floor. These can occur together.

It also describes pelvic floor weakness leading to a rectocele, where the bowel bulges abnormally during rectal emptying, which it says is especially common in people assigned female at birth who have had children, and a large rectocele can interfere with emptying. The NHS lists problems pooing, such as constipation, among the symptoms of pelvic organ prolapse, along with a feeling of heaviness or a bulge in the vagina.

These problems are assessed with an examination and sometimes specialised tests. Guts UK says anorectal physiology tests such as anorectal manometry and balloon expulsion, and proctography, are rarely carried out and mostly performed in specialist centres after simpler tests have not found the cause.

The NHS lists a feeling that you still need to poo after going to the toilet among the symptoms of piles (haemorrhoids), along with bright red blood after you poo, an itchy anus, mucus on the underwear or toilet paper, and lumps or pain around the anus. Piles are swollen blood vessels and the NHS says constipation, pushing too hard when pooing, heavy lifting, pregnancy, getting older and being overweight make them more likely.

For IBS, the NHS lists stomach pain or cramps usually worse after eating and better after a poo, bloating, diarrhoea and constipation where you may strain and feel you cannot empty your bowels fully. IBS is a diagnosis made after other conditions are ruled out, and symptoms are often triggered by food, drink, stress or antibiotics.

Cancer Research UK lists the possible symptoms of bowel cancer as bleeding from the back passage or blood in the poo, a change in normal bowel habit such as looser poo, pooing more often or constipation, a lump in the back passage or tummy, a feeling of needing to strain in the back passage even after opening the bowels, losing weight without trying, pain in the abdomen or back passage, and tiredness and breathlessness from anaemia. The NHS list is similar and includes often feeling like you need to poo even if you have just been.

Both stress that having these symptoms does not mean you have bowel cancer, since many are caused by piles, infections or inflammatory bowel disease, but that it is important to be checked. Bowel Cancer UK says that even one symptom is enough for a GP to want to see you, and that a GP may give you a home FIT test kit.

The NHS says to ask for an urgent GP appointment or NHS 111 if your poo is black or dark red or you have bloody diarrhoea, and to call 999 or go to A&E if you are bleeding non-stop from your bottom or see a lot of blood or large clots. Cancer Research UK says symptoms of bowel obstruction, such as cramping pain, bloating, constipation with being unable to pass wind, and being sick, are an emergency.

The NHS says a GP will ask about your symptoms, general health, medical history and family history of bowel cancer, may feel your tummy and may do a rectal examination, where a gloved finger is used to check for lumps. You can ask for a male or female clinician and for a chaperone. You may be asked for a stool sample or a FIT kit, and a blood test.

Guts UK lists blood tests for anaemia or metabolic problems, a FIT test, flexible sigmoidoscopy, colonoscopy or CT scan, and transit studies as tests that may be used for constipation, with most people needing little investigation. If the GP thinks symptoms could be cancer, the NHS says you may get an urgent referral, which does not definitely mean you have cancer.

Keeping a note of your symptoms before the appointment helps. Bowel Cancer UK suggests a symptoms diary, and Guts UK suggests writing down details so the GP can decide which tests are needed.