What is proctalgia fugax?
Proctalgia fugax is anal pain that doesn’t have a specific cause. This pain is usually caused by intense muscle spasms in or around the canal of the anus. It’s similar to another type of anal pain called levator ani syndrome. The pain is slightly different in levator ani syndrome, and may last days instead of minutes.
Anyone can experience proctalgia fugax. However, it doesn’t usually affect anyone prior to the start of puberty and seems to affect more women than men. It’s unclear why this is, or if it’s due to more women reporting the issue, as many people don’t do so.
The symptoms of proctalgia fugax are muscles spasms in or around the lower rectum area or in or around the canal of the anus. The pain or spasm happens suddenly, and usually without warning. The pain can be severe and will last for only a few seconds, although it can last up to 30 minutes in some cases. These episodes may be severe enough to keep you home from work. They may limit your other activities until the episode is over.
The pain will usually stop on its own. Patients with proctalgia fugax don’t have any anal pain between spasms. There can be long periods of time between spasms.
The pain or spasms usually occur at night and may be painful enough to wake you from sleep. They can also occur during the day.
Causes and triggers
Proctalgia fugax isn’t known to have specific triggers. However, some studies have shown that it may be caused by an issue with the pudendal nerves. It often happens after an injection procedure for hemorrhoids called sclerotherapy, or after a vaginal hysterectomy.
Other possible triggers may be:
- sexual activity
Despite some evidence that there are some possible triggers like those listed above, it’s also common for proctalgia fugax to occur without anything triggering it.
Proctalgia fugax and stress
Some studies seem to indicate that stress may cause the onset of spasms.
Proctalgia fugax and your period
Menstruation is believed to be a possible trigger for proctalgia fugax, but it’s unclear why. This may be one reason more women tend to have the condition than men, but that hasn’t yet been determined.
How is it diagnosed?
Proctalgia fugax is normally diagnosed after other possible causes of anal pain and spasms have been ruled out. In order to rule out other conditions that may be causing the pain, your doctor may:
- conduct a physical exam
- ask questions about the pain severity, duration, etc.
- check for hemorrhoids, fissures, an abscess, and other diseases or conditions that might cause anal pain
Once other conditions have been ruled out as the cause of your pain, your doctor will be able to diagnose proctalgia fugax.
Management and treatment
There are several treatment options, but getting relief from the symptoms is different for each person. Since there isn’t a specific cause, treatment focuses on managing the symptoms. If a trigger has been identified, then that trigger should also be managed.
If stress seems to be a trigger, then counseling may help. Warm baths and enemas of warm water may also be used in treatment. Your doctor may recommend that you apply glyceryl trinitrate or other prescription ointments.
If your spasms are severe, you may be a candidate for Botox injections in the area, or an anesthetic block may be injected locally.
While proctalgia fugax doesn’t have a specific cause, there are some conditions that may be associated, or that commonly occur at the same time. Some of these include menstruation and constipation. Many times, an episode of these painful anal spasms can be associated with psychological issues like anxiety, depression, or stress. Other conditions that may have an association with proctalgia fugax are anal fissures and abscesses, as well as rectal cancer.
If you have anal pain of any kind, it’s important that you discuss it with a medical professional. This pain can be a symptom of a disease or condition that needs to be addressed. However, if no other condition or disease is found to be causing the pain, and you’re diagnosed with proctalgia fugax, there are treatments that can help manage the episodes. If the pain and spasms seem to be related to times when you have an increase in stress or feel depressed, counseling or therapy may be recommended.