Proctalgia Fugax Is A Pain In The Butt

A man with pain shooting up his back. (Zoonar/Thinkstock)
A man with pain shooting up his back. (Zoonar/Thinkstock)

You have pain in the butt which comes and goes. You see a doctor. You want to know if you have hemorrhoids or cancer. Well, what else could it be?

There are at least six common causes for rectal and anal pain: pruritus (itch), external thrombosed hemorrhoid (a blood clot), prolapsed internal thrombosed hemorrhoids, fissure (tear), abscess, and fistula (tunnel). Ok, you can add one more condition to the list – proctalgia fugax.

Your next question is, “Doc, what is proctalgia fugax?”

This condition was first described in Ancient Rome over 2000 years ago and still carries the Latin name which translates to “fleeting rectal pain.” It occurs in about 14 percent of healthy people. Seventy five percent of these are women.

Sufferers of this condition often describe waking up from a sound sleep with a sharp pain, often described as stabbing pain “like a knife sticking deep in the rectum.” The pain is usually brief – lasting less than 20 minutes – and disappears as mysteriously as it comes.
Proctalgia fugax falls under the category of “unexplained rectal and anal pain”. Other conditions under this group are levator ani syndrome and coccygodinia.

Let us try and understand some anatomy first.

Colon ends in the pelvis to become sigmoid, rectum and anus. Sigmoid and rectum act as storage area for fecal matter. At a socially convenient place, the anal sphincters (valves) relax to allow us to defecate.

Anal canal is surrounded by two circular muscles known as internal and external sphincters. Rectum is surrounded by and held in place by pelvic floor consisting of a group of muscles called levator ani. Coccyx is the tail end of the spine, not too far from the anal canal.

Proctalgia fugax can begin during sleep, defecation, urination, or intercourse. The character of the pain has been compared to a charlie horse. It may only occur once a year or several times a week. Pain may be severe enough to cause sweating and palpitation. There may be a desire to have a bowel movement, yet pass no stool.

It is thought that a sudden spasm of the levator muscle complex or the sigmoid colon can result in proctalgia fugax. It is believed that people who frequent the toilet are at greatest risk. Professionals, managers, and perfectionists are more likely to be afflicted. Stress and anxiety plays a role in precipitating the pain.

The diagnosis is based almost entirely on the patient’s history. Clinical examination is usually negative. Patients should undergo flexible sigmoidoscopy to screen for other causes of ano-rectal diseases. Careful pelvic and prostate examinations should be undertaken. Ultrasound or CT scan of the pelvis may be necessary.

Patients with levator ani syndrome experience pain for hours to days. The pain is most often constant or rhythmic and may be likened to sitting on a ball or feeling like a ball (or corncob) was inside the rectum. Pain may be caused by defecation, sexual intercourse, sitting for long periods, and stress or anxiety. The pain is probably due to spasm of the pelvic floor muscles.

Coccygodynia is a cramp or ache in the tailbone and typically results from injury to the coccyx or arthritis. Movement of the coccyx can reproduce the pain. Pain from proctalgia fugax, levator syndrome, and coccygodynia may be hard to differentiate.

Treatment is often unrewarding. Some of the measures worth trying are: reassurance, hot baths, bowel regimens, massage therapy, perineal strengthening exercises, pain killers, anti-inflammatory, muscle relaxants, topical nitrates, tranquillizers, calcium channel blockers, acupuncture, and psychiatric evaluation.

Unfortunately, proctalgia fugax is one of the many medical conditions for which there is no good explanation or treatment.

This article was mentioned in my video blog (Had Your Butt Checked Out Lately?) on September 25, 2011.

Topics on my website: Proctalgia fugax and Hemorrhoids.

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  1. I get this pain occasionally and it’s awful. I will have weeks where it flares up nightly then leaves for months. It always happens at night and makes me feel like I need to use the bathroom but I don’t. I have found taking an extra strength Ibuprofen and laying on a heating pad usually helps it pass fairly quickly if I can catch it when the flare up first starts. I sympathize with those who experience it more frequently.

  2. Am in my 30’s now, and have had this for a long time, maybe 20 odd years. Mother and sister also suffer, I think they still do to this day. At the time doctor gave us suppositories but they didn’t really work. Sometimes the pain is bearable and only last ~20mins, but I’ve had ones that near make me pass out and last a few hours. I’d say average time is around 40 mins. As others have mentioned, mine mostly during the night but do get the odd episode during the day, sometimes at work. I put it down to stress, tiredness, but has also come on randomly after sex or defecating.

    To ease the pain I get into a squat position and rock back and forward, or get onto my knees and face on the floor and try and get things stretched and pass some gas. It is such a hassle of a condition, as you can’t talk to people about it, and when an episode occurs you just want to be left alone.

  3. Man, I get this all the time around the time of my period and it totally doubles me over and I can’t breathe it’s so bad! Good to know other people have it as well and it is not serious (just unpleasant!)

  4. I get this occasionally but it’s only after I eat too much, usually the day after. How much are you eating? Are you really stuffing yourself? For me the key to avoiding this pain is to just not eat huge meals with desserts and appetizers. But I do understand what works for me may not work for you. One other cause of this pain for me is when I take ibuprofen and I engage in intercourse after. It never fails to cause great pain. Good luck.

  5. Jeff Palmer says:

    Wow! I am not alone……… Having read people’s comments, I find many of my symptoms described exactly. Waking in the night with a really deep rectal pain. Even though I know I will not be able to open my bowels I often find that a period of straining on the toilet really helps. My symptoms last only about 30 minutes and passing some gas, even if only a little, does appear to relieve the situation . I too, often feel like I am going to pass out and have nearly fainted before. I get this only about 5 times per year but do see a link between my stress levels e.g. having been up working late at night on a deadline piece of work

    So my self-diagnosis of what is happening has led me to the following conclusion (quite possibly incorrectly, and certainly not particularly clinically informed). As the bowel pretty much shuts down through the night, any gas requiring relief cannot travel through and creates a bottleneck, once it reaches a critical point, the pain mechanism wakes you up and the bowel is kick-started. Awaking very quickly from a deep sleep whilst your blood pressure is quite low, and exerting yourself combined with the pain and the blood being demanded by the bowel to kick-start, leaves the brain without sufficient blood (hence nearly/actually passing out/fainting).

  6. I just notice pain just above my anus just a month ago… when i get up from sitting i can feel the pain, but the pain is tolerable. But the pain i felt is not permanent sometimes i didn’t feel the pain at all but still it worries me… I’m 44 now…

  7. Anyone who has this condition needs to try the medication hyoscyamine. hyoscyamine is a smooth muscle relaxer. It’s cheap, just have your physician write a prescription for you. I carry a little pill vial around on my keychain with three of these any where I go. If I even remotely start to feel an episode coming on, I’ll pop them under my tongue and let them dissolve. This usually either completely eliminates the episode, or makes it much less worse than it would be otherwise (i.e., I don’t vomit or pass out from the pain). If it occurs when I am home, I will also run a hot bath and sit in it for a few minutes until everything relaxes, but when you’re out and about, you just can’t run to take a bath. I’ve been out jogging before and had an episode come on and ended up passing out in a strangers yard by the sidewalk from the pain. There is nothing more embarrassing than having people come up to you asking if you’re ok, and you just want them to go away so you can try to relax and hope it stops soon.

    • After suffering from severe levator ani pain every few months for 25+ years, my doctor finally prescribed hyoscyamine and I agree with Ed — it’s a life-changer! I’ve only tried 1 tablet at a time under my tongue, but it can either stop the pain if I catch it quickly enough, or greatly reduce the pain if I’m too late to stop it. When I say reduce, don’t get me wrong — it’s still miserable, but 1 tablet usually pulls me back from the edge of passing out, and shortens the duration of the episode from about 2 hours to 45-60 minutes. I also lie face down on the floor on a heating pad either below my stomach (since the “hot poker” seems to go through my body from the rectum to just below my belly button) or I sit on the pad if I can manage to sit. Before hyoscyamine, usually all I could do was pace around, hyperventilating, trying not to pass out from the pain (but kind of wishing I would), wondering what I did to deserve this in my life. Now things are at least a bit more manageable, although still irritatingly mysterious. I might try a couple tablets next time to see if that works even better. One note: my doctor said the medicine basically relaxes the gut, and I can feel it doing that for several hours. I’ve even used it once (from my keychain supply!) when I was away from home and started getting an upset stomach and it calmed the whole thing down, so whatever it does, I’m glad my doctor recommended it.

  8. My story is pretty much the same as Andy Mack’s above. I’ve been dealing with this ailment for about 10 years now. Comes on to a varying degree about once every two or three weeks on the average.

    I have learned over the years how to cope with it. First, my opinion is this problem is gas related as I am somewhat gassy in nature. Maybe it’s something I eat that makes me this way. Not sure but my youngest son is also gassy so I think it may run in the genes.

    Basically the remedy is to pass some gas to relieve the pressure. The reason the attacks usually come on at night is because gas builds up during the night. I have also found that sitting on the floor, pulling my knees up to my chest and doing a rocking motion on my rear helps massage the pain away. It helps to sit on something like a rolled up towel so the pressure can be focused on the anus area. Sometimes I just do sit ups on the rolled towel. This way I relieve the pain and get some good exercise too. Normally when I’m doing my rocking or sit ups I end up passing a small amount of gas and then the pain is gone completely.

    Next time you have an attack, try it yourself. Works for me every time.

  9. Tom in MO says:

    Wow!!! Im not dying!!! I have had this since I was 18, Im now 40. Doctors really need to figure this out. I have had so many tests over the years and nothing ever found. The doctors seemed to always think I was making it up in an attempt to get pain medication or something. I have dealt with pain so severe that I thought I was going to pass out at times ranging from 1 hour to 4 hours and it mostly wakes me up in the middle of the night but it has come on at all different times but mostly about and hour or two into sleep. I believe stress and large amounts of aspartame from diet drinks are big causes of mine. I have also experienced it after bowel movements, sex, and sitting for long periods of time.

  10. Im a 44 female just stated getting a sharp pain in the butt, wakes me up only lasts for a oople minutes then it goes away . What can I do for this.

  11. I’m a 44 year old male. I’ve been dealing with this for 25 years. It was very frustrating since I, nor anybody else, knew what was wrong with me. I didn’t know what it was until I stumbled upon it online. What brings it on for me is when I defecate when I don’t have to go badly. This means that I have to wait until I really have to go before defecating. Also, sex with my wife occasionally brings it on. The pain doesn’t start until after we’re done. It has lasted from 15 minutes to 5 hours, but that’s rare. It’s nice to know I’m not crazy or dying.

  12. I have had this pain since about 20 years old. It happens most often at night I have found sleeping on my side or on the stomach night it is worse. Therefore I have made an effort to sleep flat on my back. sleeping on my stomach will induce it within an hour of going to bed. sleeping on my side will also cause it but not as often. Sometimes having a bowel movement will cause it also. I’m not sure to type of pressure because time sometimes passing gas relieves it. Pain is so great that I almost want to pass out. I have found relief in a hot bath. Running water almost as hot as you can stand it. It can take from 20 minutes to several hours to go away completely. My biggest fear is getting durin a meeting or when I’m at work. And it has happened and I have to excuse myself at those times and I have found and drinking large quantities of very hot water helps. Sexual activities and sometimes also bring a problem. No one seems to understand this pain and I have talked about it and they have not thought of anything to say to me. It can occur as frequently as twice in a week or once a month.

    • martin murphy says:

      Andy you appear to have identical experiences to me. The drinking of very hot water must affect you in the same way. What I did was place my hands in very hot water, as hot as I could stand, and this gave such a sharp shock to the system that the pain abated. I must confess that I’ve never experienced proctalgia fugax outside of night/bed-time.

  13. I describe my pain as a rectal Charlie horse. I’ve had about 5 episodes in about 5 years and they last about 15-20 minutes. Mine never happen at night. Either I have been shopping or I just went to the bathroom. Neither my doctor, or my acupuncturist, knew anything about it, yet didn’t seem concerned when I asked them. Knowing others have it, and reading this site, has eased my concern and worry.

  14. I couldn’t sleep tonight because this has been worrying me too. I’m a 30 year old male, and this has been getting more frequent for me. Extremely painful for a brief period of time if during the day. If it wakes me at night, it is painful to walk and very painful to urinate. It feels like its in the anus, up a few inches I guess. Sometimes it radiates to the bottom of my male parts. It has brought me to my knees before. Passing gas does releive the pain. Flexeril before bed seems to help too. I notice when I am lifting too much it happens more frequent. Just glad to know its likely this and not prostate issues or a bladder or kidney stone. Thanks for everyone sharing!

  15. I’ve discovered relief by sitting in a bath of water. The water needs to be as hot as you can bear and I guarantee you’ll get relief

  16. This has been happening to me for years…what I do is put Prep H there right away and it takes away the pain…sometimes is makes me want to crawl with pain…thank God I found this to see other people have this…

  17. It’s such a relief to find this page and read the above comments. I’ve gotten these pains since my late teens and their bloody awful. One thing I found that helps after trying a bowl movement is ponstan it’s for period pain but it helps my butt pains :)

  18. I have been suffering from this problem for years. I am 56 years old now and it is normally always at night that it comes on. I had it last night and it was really bad on and off for around 3 hours. It is such a relief that others are talking about the same thing as me – that makes it far more easier to deal with. I had a colonoscopy a couple of years back and spoke to a Doc about it, who said it was because I was a naturally nervous person. I didn’t think much to that at the time but there is safety in numbers!
    I always feel better if I can pass wind or go to the toilet and can spend a lot of the time back and forwards to the loo. It always wakes me out of sleep. Sometimes I can get relief from it, only for it to start again later on. I used to get it close to my menstrual cycle, which is a bit erratic now but it still seems to have an effect.

  19. I am so glad I found this site. I am a 50 year old woman and over the past 10 years have become healthier and more fit than I have been in my entire life, so I was pretty sure this was not a fibre or bowel issue. In the last few months these ‘pains’ have occurred now 3 times. Last night was very bad. I woke up at 3 a.m. with stabbing pains, I also felt constipated and having a bowel movement seemed the only way to ease the pain. In tears, I sat, shaking and sweating, wondering what I should do next. I then got very nauseous. Great! Before I could decide to sit or stand I found myself waking up on the bathroom floor curled up in a ball. Pain was gone. I was scared! Not exactly sure how long I was there. Not that I am glad anyone else has ever gone through this but glad to know that it is something that is documented and nothing to worry about. I know now that next time (hopefully not) to use pressure and drink water! Thank-you all for sharing.

  20. I knew I wasn’t crazy. I’ve had this going on (always at night) for 7 years. I’ve inquired with my obgyn (thinking it could be related to a prolapsed uterus or other gynological abnormality), but she offered no thoughts or help. I’ve searched the web for answers, but could never come up with anything that seemed 100% an explanation. I finally typed in “rectal pain at night waking me up” (after losing another 1.5 hours of sleep over a 15 minute bout last night), and was led here. I’m a worrier (health related anxieties). My husband has told me to seek out answers via doctors if I feel compelled, but if this was something like cancer…wouldn’t I be quite advanced with it after 7 years(?). Good point. I feel completely assured after reading this that this is what I am experiencing. Thank you, thank you, thank you!

  21. I too have suffered from this pain in the bottom for years, always during the night. Same as most other people it wakes me up & it is very painful. Its impossible to go back to sleep. I only just recently heard the name proctalgia fugax. I even saw a specialist and my dr a couple of times and they didnt mention it. So ive had years of stressing that i have had some horrible condition. I generally do a bit of stretching, squating. Think massaging t area with abit of pawpaw cream helps abit. Try to relax & just wait it out. Its a huge relief to know its quite common. I just bought some Fiorinal today which was recommended. Pain relief,muscle relaxant so next time i get it im going to give them ago


  22. Finally I have found out what has been happening to me for years several times a week. Middle if the night pain that almost makes me vomit from the nausea only relieved by sitting on the loo! Thankyou for finally giving me the answer :)

  23. I’m about 19 years old and I had just woke up about 10 minutes ago with a headeach kind of pain in my behind and the only thing that seemed to make it go away was to try and have a bowel movement. It scared me because I had no idea what was going on with my body so, I googled it and came across this! It’s been very helpful and I’m going to consult my doctor asap!

  24. Theresa says:

    I have had this since my early teens. For me the pain is so debilitating. It lasts for and hour or more and feels like nerve pain. Very sharp, shooting pain it brings my to my knees and takes my breath away. I have a hard time standing or moving from point a to point b. Trying to have a bowel movement helps but is extremely painful too. The pain shoots me right off the toilet. It just usually takes time to run its course I guess.

    • My mom has this same pain that you describe. She says that she’s constantly in pain every single day. She takes pain meds and it only takes a slight edge off of the pain. She has had two colonoscopies and the doctors cannot find anything wrong. I have watched her cry day in and day out and she even has to go to the hospital for shots to ease the pain. All the doctors treat her like an addict and have no sympathy for what she is going through. This is a woman who for years didn’t even take Tylenol. I wish I knew how to help her she just turned 51 and has been dealing with this for the past 5 years and it is debilitating.

  25. Steve D says:

    I concur with Jamie & Martin. I had this last night, but thankfully, it only occurs once a year or so. When it does, the pain can only be described as like someone putting a hot poker up my backside – it is an extreme ‘burning’ sensation type of pain. It usually occurs in the middle of the night, but also occasionally when having a bowel movement. It can be mild (still very painful), or severe, when it is very debilitating and I can almost pass out (very nearly did once). The only thing that seems to help is to try to have a bowel movement, i.e., stressing the anal muscles. Sorry to hear this is so common, but at least I know it’s not just me! I’d be very interested if anyone has found anything that seems to trigger this, or has found anything that helps.

    • jenny Waters says:

      Hi….I have suffered with this problem for ages….I use Vick vapour rub….It soothes the pain away…and find it works

  26. nbharwani says:
  27. I have ask doctors about this pain and not one of them has told me about this condition . I’ve had it for about 10 years or more and the one thing that helps me is to try to have a bowel movement most times I can’t but it seem to help a lot . Also getting a towel and make it into a circle or into a ball and sit on it . It puts pressure on the retcum and relives a lot of the pain . I have had test and everything’s is good and this problem is word for word how I’ve tried to explain to my doctor and my husband what’s going on when I wake up in this horrible pain . Glad to know other people have the same type of symptoms . .

  28. I’m so glad I was able to find out what the name of this condition is. I’m 23 years old. I don’t get it very often but when I do, it usually happens at night. The last time I had it was a few days ago and it woke me up around 5:30 am. It usually lasts about 20 minutes to half an hour for me. It’s not sharp or excruciating pain but it does hurt and it’s very uncomfortable.

    • martin murphy says:

      for me the pain is much more debilitating. it is not a pain which you can apply a hot water bottle or cold compress to and, as such, a mild panic overtakes me. It leads to an increase of the anxiety and the pain On a few occasions I have actually lost consciousness. This website has given me confidence to even mention it to my doctor who knew what it is. That is reassuring.

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