Proctalgia Fugax (Rectal Pain)

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What Is Proctalgia Fugax?

Proctalgia fugax involves having episodes of sharp, cramping pain in the anal canal and anal sphincter. A type of functional recurrent anorectal pain, the discomfort during proctalgia fugax episodes can be intense, but usually lasts only a brief period and then disappears without any lingering discomfort.

The exact reason why proctalgia fugax occurs isn’t clear, but it’s believed to be related to muscle spasms in the anal sphincter or the muscles of the pelvic floor, possibly due to stress, nerve-related issues, hormonal activity and other factors.

What Are The Symptoms of Proctalgia Fugax?

The primary symptom of proctalgia fugax is the sudden onset of sharp, temporary pain in the rectum or anus. This anorectal pain is often described by patients as aching, cramping, gnawing or stabbing.

The intensity of the pain during a proctalgia fugax attack can vary, but it is often severe. For most patients, the episodes are fairly infrequent, occurring less than five times a year, with patients usually not experiencing pain between episodes.

While other functional gastrointestinal disorders can cause anorectal pain symptoms, proctalgia fugax can be considered as a diagnosis once these other issues are ruled out by a healthcare provider.

What Causes Proctalgia Fugax?

The exact cause of proctalgia fugax is not well-understood. However, it’s believed to be related to spasms of the anal sphincter or pelvic floor muscles.

Compression or damage to the pudendal nerve, the main nerve that sends electrical signals to and from the anal and genital region of the pelvis, may also be a contributing factor.

Additionally, it’s suspected that hormonal issues, certain medical procedures involving the anus or pelvic organs or problems with communication between the brain and digestive tract might also play a role.

What Can Trigger a Proctalgia Fugax Episode?

The exact cause of proctalgia fugax is unknown. However, there are certain situations that might precede or trigger episodes of pain in some patients. These include:

• Having a bowel movement
• Constipation and straining
• Sexual activity
• Menstruation
• High stress or anxiety

In addition, some people may begin experiencing symptoms after certain medical treatments, including sclerotherapy to treat hemorrhoids or after undergoing a vaginal hysterectomy.

How Long Do Proctalgia Fugax Attacks Last?

Pain from an attack of proctalgia fugax may be intense, but it is usually fairly short. Some people experience pain for only a few seconds, while others may feel discomfort for up to 30 minutes. The pain can be severe while it lasts. After the episode, however, discomfort usually disappears completely.

Proctalgia Fugax vs. Levator Syndrome

Both proctalgia fugax and levator syndrome (levator ani syndrome) are types of functional anorectal pain. Levator syndrome is caused by spasms in the levator ani muscle near the anus. Why this muscle tends to spasm in some people and not others is unknown.

One of the major differences between levator syndrome and proctalgia fugax is the duration of symptoms. Proctalgia fugax usually involves episodes of intense, fleeting pain in the anus, but these episodes are usually short, and patients often feel no discomfort between episodes.

Those with levator syndrome, on the other hand, can experience both brief episodes or episodes that last for hours, with the pain usually getting worse when sitting but lessened by standing up or lying down.

How Is Proctalgia Fugax Diagnosed?

If you have issues that might suggest proctalgia fugax, your doctor will likely ask you about the symptoms you’re experiencing, their duration and your medical history. Any surgery or treatments you’ve received involving the anus or pelvic area will likely also be medically reviewed.

Usually, the physician will conduct a thorough physical examination, often including a rectal exam. Diagnosing proctalgia fugax involves ruling out other conditions that can potentially cause intense or recurring rectal pain. Conditions that might be considered during this process include:

• Hemorrhoids
• Anal fissures, which are tears in the lining of the rectum or anus
• Rectoceles, which are weak spots in the wall between the rectum and vagina in women
• Rectal abscess, which is infection in the lining of the rectum

What Conditions Other Than Proctalgia Fugax Can Cause Pain In The Anus?

Other conditions that can cause anal pain include:

• Hemorrhoids, which are caused by swollen veins in the anus and rectum
• Anal fissures, which are tears in the lining of the rectum
• Rectal abscesses, which are pockets of pus and infection that can develop in the rectum
• Rectoceles, which is a weakening of the tissue between the rectum and vaginal wall
• Levator ani syndrome, which can cause persistent pain in the rectum

Are There Any Serious Complications Of Proctalgia Fugax?

While proctalgia fugax can sometimes cause temporary bouts of severe pain in the anus, it is not considered a life-threatening condition. However, in rare cases, the sudden, intense pain from the condition might cause those with the condition to faint.

Which Medical Tests Can Diagnose Proctalgia Fugax?

A physical exam is usually the first step in reaching a diagnosis of proctalgia fugax. During this exam, your healthcare provider will usually check for any damage, irritation or issues involving the anus and rectum that might be causing the pain you’re experiencing, including hemorrhoids, rectal abscesses and anal fissures.

Depending on the outcome of the physical exam, tests may be ordered to diagnose or rule out certain conditions that may cause anorectal and pelvic pain. Once these causes have been ruled out, a diagnosis of proctalgia fugax should be considered if the episodes continue.

How Is Proctalgia Fugax Treated?

There’s no known cure for proctalgia fugax, so treatment focuses on relieving symptoms and helping patients avoid factors that may trigger episodes, including constipation and excess stress.

Warm baths can help relax spastic muscles and alleviate pain. If spasms in voluntary muscles are thought to be a contributing factor, certain exercises and relaxation techniques may be prescribed to assist in pelvic muscle retraining.

In severe cases in which attacks happen frequently (AKA chronic proctalgia fugax), treatment options like pain medications might be prescribed to help patients control muscle spasms in the pelvic area, lower rectum and anal passage. There are also a number of promising treatments that may help control symptoms of functional anorectal pain, including electrical stimulation and Botox injections

Are There Any Medications To Treat Proctalgia Fugax?

If it’s believed a patient’s proctalgia fugax symptoms might be related to bowel movements, healthcare providers might prescribe diet changes, stool softeners and other medications that can help treat constipation and prevent excessive straining during defecation.

Medications like clonidine and oral diltiazem have also been explored as treatment options, along with nerve blocks, which can relax the muscles of the rectal area and provide pain relief. Salbutamol, an inhaled asthma medication, has shown promise in reducing the duration of pain during proctalgia fugax episodes.

Local anesthetic treatments, including topical glyceryl nitrate or diltiazem gel, might also be used to achieve symptom relief, though their effectiveness hasn’t been thoroughly medically reviewed.

Who Is Most At Risk To Develop Proctalgia Fugax?

There are only a few known risk factors for proctalgia fugax, though it is known proctalgia fugax is more common in women, and typically affects adults between the ages of 30 and 60. Individuals with irritable bowel syndrome (IBS), a history of certain hemorrhoid procedures or who have had a hysterectomy might also have a higher risk of developing the condition.

Are There Any Ways To Reduce My Risk Of Developing Proctalgia Fugax?

Currently, there is no way to prevent someone from developing proctalgia fugax or to definitively prevent attacks for those who have the condition. However, there are a number of promising treatment options for the condition that are under review, and understanding the disorder and its triggers can help patients manage and potentially reduce the frequency of episodes.