Proctalgia fugax

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at December 30, 2016
StartDiseasesProctalgia fugax

Proctalgia fugax is a muscle problem that is characterized by extreme pain in the area around the rectum. The pain is usually episodic and is classified as proctalgia fugax when it cannot be traced to any other disease. It is a relatively common problem but often goes untreated due to the embarrassment of the patient and their fear of discovering a more serious medical problem.

Contents

Definition & Facts

The distinguishing feature of proctalgia fugax is pain. The pain occurs in relatively brief episodes, with some patients experiencing it for periods of a few seconds, while others experience several minutes of agony. The pain usually occurs at night, although a minority of patients also experience the pain during the day.

The disease is reported in women significantly more often than in men, although scientists are not sure if this is because women are more prone to developing proctalgia fugax or if it is because men are less likely to report the problem to their doctors. The low rate of reporting makes it difficult for physicians to judge the frequency of the disease, but it is estimated that up to 18 percent of the population experiences proctalgia fugax at some point in their lives. 

Symptoms & Complaints

The primary symptom of proctalgia fugax is pain in the muscles around the rectum. This pain occurs in spasms which rarely last for more than a few minutes. Most patients experience these spasms near the middle of the night, while a minority also experiences them at other times of day.

The pain disappears on its own at the end of the spasm, but most people who have the disease suffer more than one episode during their lives. A significant amount of time can pass between the spasms, which can make it difficult for people to realize that they are suffering from a medical problem rather than experiencing an inexplicable bout of agony.

In addition to the pain, proctalgia fugax is often linked to tightening of the internal anal sphincter.

Causes

The cause of proctalgia fugax is not entirely clear, but physicians have identified several factors that they believe can contribute to the problem. The pain is caused by cramping in a muscle known as the levator ani, but the cause of that cramping is significantly less clear. Muscle spasms in other nearby muscles also occur during many of the episodes, which leads many doctors to believe that they contribute to the problem. Since the disease is often associated with the tightening of the internal anal sphincter, many doctors believe that it is caused by damage to the nerves in that area.

Diagnosis & Tests

The diagnostic process begins when the patient reports pain in and around their rectum. That is a symptom associated with many other medical problems, so most doctors will begin to test for other diseases in order to rule out as many potential causes as possible.

The process usually includes a physical examination that searches for signs of damage to the anal muscles, including anal fissures and inflamed hemorrhoids. The physician will also examine the general health of the muscles and look for signs of weakness or other potential issues.

If any evidence of other disorders are found, the doctor will usually treat them and only consider a diagnosis of proctalgia fugax if any painful episodes occur after that process is complete. If there are no such signs, the physician will diagnose the problem as proctalgia fugax based on the patient's medical history.

A single episode of pain is insufficient to justify the diagnosis, since one of the defining factors of the disease is repetition of those episodes. If the patient reports multiple episodes, as is often the case by the time that they seek treatment, then the doctor can be confident in the diagnosis. 

Treatment & Therapy

It is difficult to treat proctalgia fugax since the episode usually ends naturally before the patient can do anything. It is rare for a patient to experience an episode when they are in the presence of a doctor, which means they must be able to provide immediate treatment on their own if they want to solve the problem. There are a few methods that may be effective.

People who are prone to longer episodes can sometimes draw a warm bath before it ends, and use that bath to ease the pain. Meditation and other relaxation techniques can also help to reduce the pain. Some people also benefit from applying ice during their episodes, but those results are not universal.

In general, patients find that any activities that distract them from the pain can help to make the disease more bearable, but that painkillers rarely have enough time to start working before the episodes subside on their own. Since there is no way to cure the disease, treatment beyond immediate pain management focuses on taking action to prevent attacks before they happen.

Prevention & Prophylaxis

Proctalgia fugax is difficult to prevent because it is not very well understood by researchers, but there are a few techniques that are known to help. A high fiber diet can reduce some of the aggravating factors of the disease, which can lower the intensity of the attacks and sometimes reduce their frequency.

A small dose of diazepam can also prevent attacks during the night. None of these techniques offer a complete cure or a guarantee of preventing the attacks, but they may be able to reduce the impact of the condition on the patient.