Proctalgia Fugax Causes and Treatment

Proctalgia fugax is a condition characterized by brief sudden spasms of rectal pain. These attacks can last up to 30 minutes before disappearing. It affects adults and is more prevalent in women.

Its exact cause is not certain, but proctalgia fugax is believed to stem from activity of a muscle or nerve issue. It is diagnosed when identifiable causes of rectal pain have been excluded.

This article provides an overview of proctalgia fugax, including what it feels like, how it compares to other anorectal pain, why and when it tends to occur, and how it's diagnosed and treated.

Symptoms of Proctalgia Fugax

The pain of proctalgia fugax is solely experienced in the anus or rectum.

People describe it as:

• Aching
• Cramping
• Gnawing
• Stabbing

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.

Proctalgia Fugax vs. Other Anorectal Pain

Proctalgia fugax is one of three subtypes of functional anorectal pain that have this symptom but 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
• syndromeLevator ani : Persistent, long-lasting, and often chronic anorectal pain
• Unspecified anorectal pain: Cases that don't fit the other two categories
  

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.

The reason why these issues may occur is not well understood. Quite often, the pain occurs spontaneously and people really cannot narrow down a cause. Although painful, proctalgia fugax is not a sign of a serious bowel disease.

Sometimes, there may be identifiable situations that precede proctalgia fugax episodes, including:

• Bowel movements
• Constipation
• During/after sex
• During menstruation
• Times 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.

Diagnosing Proctalgia Fugax

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.

At-Home Treatment

With proctalgia fugax, the episodes of cramping may be so short-lived that you may not be able to treat them before they go away. For longer-lasting episodes, these at-home remedies may be able to provide relief:

• Warm sitz baths
• Heating pads and ice packs
• Over-the-counter antispasmodics like Buscopan (hyoscine butylbromide)
• Over-the-counter pain relievers and muscle relaxers

In some cases, dietary changes may help with pelvic floor dysfunction. Talk to a healthcare provider about increasing your intake of fiber and water to make bowel movements easier.

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. Biofeedback can help you gain control over involuntary bodily functions, which are the ones you don't consciously control.

Electrical stimulation, as well as treatments for functional anorectal pain using Botox, also are under investigation.

Summary

Proctalgia fugax causes brief spasms of anorectal pain with no symptoms between episodes. Although uncomfortable, the cramps are harmless. The causes of proctalgia fugax are difficult to nail down, but muscle spasms or nerve compression may be a factor.

See a healthcare provider if you're experiencing pain in your anus or rectum. Healthcare providers will rule out other possible causes of anorectal pain before diagnosing proctalgia fugax. At-home remedies may relieve mild pain. In more severe cases, healthcare providers may prescribe medication or perform a medical procedure.