Its exact cause is not certain, but proctalgia fugax is believed to stem from activity of a muscle or nerve issue. Proctalgia fugax is diagnosed when identifiable causes of rectal pain have been excluded.
This article provides an overview of proctalgia fugax, including its symptoms, when it tends to occur, possible reasons why, and how it’s diagnosed and treated.
Anorectal Pain Conditions
Proctalgia fugax is one of three subtypes of functional anorectal pain that have this symptom but that do not have an identifiable cause.
While proctalgia fugax and two other conditions were once lumped together under the name chronic proctalgia, each is now considered a unique condition:
Proctalgia fugax: Anorectal pain that is occasional and temporary with no symptoms between episodes. Levator ani syndrome: Persistent, long-lasting, and often chronic anorectal pain. Unspecified anorectal pain: Cases that don’t fit the other two categories.
Symptoms of Proctalgia Fugax
The pain of proctalgia fugax is solely experienced in the anus or rectum.
People describe it as:
AchingCrampingGnawingStabbing
The pain is sudden and may last a few seconds or a few minutes before going away completely. The intensity of the pain can vary widely, and it is often severe.
In most cases, these attacks are fairly infrequent and occur less than five times per year.
What Causes Proctalgia Fugax?
Proctalgia fugax pain may be due to spasms of the muscles of the pelvic floor, rectum, or anal sphincter. Compression of the primary nerve in the anal and genital region—called the pudendal nerve—may also cause these short and intermittent pains.
In addition, there is some evidence to suggest that the nervous system’s messages between the brain and digestive tract are altered in people who experience proctalgia fugax.
Why these issues may occur is not well understood. Quite often, the pain occurs spontaneously and people really cannot narrow down a cause.
Sometimes, there may be identifiable situations that precede proctalgia fugax episodes, including:
Bowel movementsConstipationDuring/after sexDuring menstruationTimes of high anxiety or stress
Proctalgia fugax may also occur after sclerotherapy for hemorrhoid treatment or after a hysterectomy. People who have irritable bowel syndrome (IBS) also may be at higher risk of experiencing this condition.
Diagnosis
As a functional gastrointestinal disorder (FGD), proctalgia fugax is diagnosed only after all other disease possibilities have been ruled out.
Diagnoses that will be considered include:
Hemorrhoids, a condition affecting veins in the rectum Rectal abscess, a pocket filled with pus in the rectum Anal fissure, a tear in the lining of the anus Rectocele, a weakening of the wall between the vagina and rectum
A healthcare provider may also rule out a psychological or behavioral health condition as well, since some cases of proctalgia fugax may be linked to anxiety and depression.
This will involve a physical examination, diagnostic tests, and potentially other evaluations.
How Proctalgia Fugax Is Treated
An important part of treatment for proctalgia fugax is knowing that, although painful, the condition is not serious. Your healthcare provider is likely to be supportive and explain your symptoms. Some of the recommended treatments may include warm baths to relax your muscles.
You must report symptoms for at least 12 weeks of repeating episodes of pain in your rectum. These do not necessarily have to be consecutive. The episodes must be of short duration. You must not experience any pain in that area in between episodes.
Medication
Medication may be an option in more severe cases. Drugs including clonidine and diltiazem (which are typically used to treat hypertension) have been tried without any significant findings from study results. Salbutamol (albuterol), a bronchodilator used to treat asthma, appeared to limit the duration of pain when studied in an older drug trial.
Topical therapy at the onset of rectal pain/spasm can be attempted using rectal nitroglycerin or diltiazem gel, although its benefit is not clear.
Specialist-Driven Procedures
Exercises and biofeedback also may be used to treat proctalgia fugax due to its likely association with pelvic floor muscle function. In some cases, dietary changes may help with pelvic floor dysfunction.
Electrical stimulation, as well as treatments for functional anorectal pain using Botox, also are under investigation.
