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Rectal Steroid for Tumour Tenesmus — SCE Palliative Medicine MCQ

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ModerateGI SymptomsRectal Steroid for Tumour TenesmusSCE Palliative Medicine

A 72‑year‑old man with advanced colorectal cancer has severe tenesmus and mucous discharge from a rectal tumour. He describes a constant urge to defaecate with minimal stool production. He has already received palliative pelvic radiotherapy. Which topical agent may provide symptomatic relief?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Rectal corticosteroid suppositories (e.g. hydrocortisone) to reduce local mucosal inflammation

Explanation lettering: D = shown as A · E = shown as C · C = shown as D · A = shown as E

The correct answer is E. Topical corticosteroid suppositories deliver anti-inflammatory effects directly to the rectal mucosa, addressing the pathophysiological basis of tumour‑induced tenesmus when radiotherapy alone is insufficient. Paracetamol suppositories (A) treat pain but not tenesmus. Loperamide (B) slows gut transit and may worsen tenesmus by increasing retention. Glycerine (C) is a laxative that could exacerbate the urge. Metronidazole (D) is antibiotic and not indicated unless infection is present. This formulation and recommendation are supported in UK palliative care practice.

Reference: RUH NHS Palliative Care Handbook (Rectal and Pelvic Pain: Tenesmus) 2026; NHS.uk 'About hydrocortisone for piles and itchy bottom' 2023