You have an urge to poop; soon after sitting on the toilet you’re overcome with severe lower abdominal pain; as you strain your body starts shaking.

What on earth can this mean?

It’s common for people to experience a pressure-like discomfort when a big bowel movement is coming. This is a signal to find a toilet.

But sometimes, the pain is a different kind – a severe kind that really hurts.

The pain feels as though there’s more to it than just stools crowding up in the lower rectum and ready to be voided through the anal opening. The pain is so bad that one may find themselves shaking or shivering.

Usually, the severe lower abdominal cramping is relieved as soon as stool is voided.

“As many of us can attest, there is a sense of when we need to have a bowel movement, and this sometimes is associated with some perceived activity in our abdomen (rumbling or gurgling sounds, mild queasiness, a sensation of intestinal movement, etc.),” explains G. Shelton McMullan, MD, board certified gastroenterologist at MedStar Franklin Square Medical Center.

“Some individuals experience abdominal pain prior to, during and/or after having a bowel movement,” continues Dr. McMullan.

“This can, of course, occur in the setting of being constipated and, for the millions of Americans who have regular intermittent abdominal pain and fluctuating bowel habits who find either relief or worsening of their pain with defecation, the symptoms are a manifestation of irritable bowel syndrome (IBS).”

Keep Track of Your Poops

• Is the unusually severe cramping only very occasionally?

• Is it always associated with straining to void hard stools? Or are the stools sometimes or usually softer/normal, loose or diarrhea?

• Does the pain only occur if the BM comes overnight or first thing in the morning?

• Are these painful bowel movements associated with binge eating?

Diagnosing Irritable Bowel Syndrome

The clinical picture is very important, and accurate patient feedback is crucial, as part of making an IBS diagnosis.

However, if a doctor diagnoses you with IBS but has not performed a colonoscopy…you’ll want to consider seeing another physician.

That’s because IBS is a diagnosis of exclusion. Conditions that a colonoscopy can detect are known to cause symptoms that can be mistaken for those of IBS – such as microscopic colitis (though this condition causes diarrhea, not constipation).

What about the shaking or shivering?

“There can be many possible causes of shaking or shivering associated with abdominal pain while trying to defecate, as this is a very non-specific symptom,” says Dr. McMullan.

“The activity of bearing down when trying to poop can lead to some individuals feeling lightheaded, and this can potentially cause one to perhaps shake or shiver.

“The occurrence of this only when defecating is probably not concerning.

“But otherwise frequent shaking and shivering should be reported to one’s healthcare provider, as this can be seen with infection, electrolyte disturbances (imbalances of sodium or potassium, for example) or with thyroid gland dysfunction, for example.”

Another explanation for the trembling is the anxiety that comes when one is hit with severe pain while sitting on a toilet. This is quite unsettling.

Dr. McMullan has published numerous medical abstracts and presented posters related to the management and treatment of inflammatory bowel disease and other gastroenterological conditions.