Proctalgia Fugax Is A Pain In The Butt
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.
Disclaimer: Dr. Noorali Bharwani and Noorali Bharwani Professional Corporation do not warrant or guarantee the accuracy, completeness or timeliness of the information found at this site or the sites listed here and do not otherwise endorse the information contained in them. Dr. Noorali Bharwani and Noorali Bharwani Professional Corporation assume no responsibility or liability for damages arising from any error or omission or from the use of any information or advice contained in this site or sites listed here. The information provided here is for general knowledge. For individual health problems seek the advice of your doctor.
Comments
By meredith on February 11th, 2009 at 9:29 am
Thank you for this . It’s a relief to know others are experiencing what you called Proctalgia Fugaxartical. Though horrible, I’m now not in a total panic. The ‘ball’ description is exactly what I go through. The percentage of people that have this is probably higher, as I be a lot of women just won’t mention it! Thanks again.
By Sonja on February 23rd, 2009 at 2:04 pm
I just spoke with my Doctor to find that I experience Proctalgia Fugax and knowing this will assist in how I can deal with such episodes. Since episodes have in the past been far between I actually didnt want to bother making a specific appointment for this but my most recent attack was so severe that I had to check it out .. I felt really strange trying to describe the events of an attack but the Doctor soon assured me of the ailment. Just knowing has put me at ease and that in itself is important.
By Terry on February 26th, 2009 at 8:47 am
this is going to sound weird, but trust me it works. its all about prevention, because once it starts it has to run its course. the anus is a dry place, so intercourse, sitting or what ever forces the anus “out of place” thats when the cramps start. so if this is what I do. everynight before bed I use KY jell to lube my anus, allowing it to slide back into the natural position, therefore cramps never start. I went from having 10 events a month to maybe 3 or 4 a year. try it youll see.
By Adam on February 28th, 2009 at 5:19 pm
fantastic and helpful article. I experience this a couple of times a year, no more than 4 tiimes. Aspirin is the only thing that helps along with stretching and walking around. Taking your mind off of it is a big help, distraction and not thinking about the pain makes it go away.
By Anna on March 7th, 2009 at 3:55 am
Thank you so much, it sounds like I have proctalgia fugax. I actually told the doctor about it and she just looked at me funny and sent me home without saying anything about it at all. Needless to say… she is not my doctor anymore. However, I never got up the nerve to try to explain the episodes to my new doctor. Anyway. they happen about 3 times a year. I just had an episode where it woke me up out of my sleep and it lasted for about 17 minutes. I am really relieved to know that it is not something really serious. This article helped me a lot. Thanks.
By Gayna on March 17th, 2009 at 4:27 am
I have been doing a lot of research on this myself. After the birth of my son in Dec 2008 (I had a long, painful labour that ended up being an unplanned c-section), I began experiencing these painful spasms on a daily basis. I guess I have the chronic condition called Levator Ani Syndrome. I’ve had several diagnostic tests done to rule out anything ominous, so am starting physiotherapy, but am unable to find a therapist (would it be a physiotherapist??) who is familiar in treating this specific condition.
By isabel on April 2nd, 2009 at 10:42 pm
Wow thank-you so much for enlightening me on this subject. For years I have suffered and never got an answer from any doctors.
Just recently I went to naturpathy doctor and he came out with the name right away. For me it has been a live and learn experience. With a couple of episodes in the past and having such excruciating pain to the point of fainting. I have found the only relief I get is to supress it before it reaches that point with very hot compresses until it subsides.
Somtimes I get awoken from sleep. long periods of sitting somtimes brings it on, or during intercourse. Usually less than 6 times a year.
By susan on May 14th, 2009 at 9:04 pm
I cant believe i have actually found the answer to my problems. My symptoms are exactly that, i wake up in the middle of the night with stabbing pain in my butt. I always just ignored it and hoped it would not happen again, i would take advil and just wait it out and it would go away. I always was trying to thing of ways to explain it to a doctor but all i could think of is that it felt like someone was stabbing me in the but with a knife. I now find out that, that is how people describe it. It is nice to know i am not the only person going through this.
By Raelyn on May 21st, 2009 at 1:00 am
Hi, I also have been really worried about this. Especially with the Farrah Facet cancer story circulating. Actually my pain which only happens occasionally is more stabbing and then it feels like a dull ache that radiates. It is really uncomfortable. I have been really worried about it and have been tested in the past with nothing coming up. I guess it is time for me to have a more thorough exam to make sure it is nothing serious. I am really relieved by all these informative posts. Thanks for sharing. I guess none of us are alone.
By Lynda on May 21st, 2009 at 2:15 pm
Wow, I’ve had this off and on for years and now it has a name. I always called this “the pulling pain,” because it feels exactly like someone is trying to pull all your internal organs out through your anus and vagina. You instinctively want to put pressure on your anus to hold everything in but I found that just the opposite helps a lot. Bear down really hard like you are trying to defecate…it helps a lot!
By Lynda on May 21st, 2009 at 2:16 pm
PS…it sometimes happens to me after orgasm. Other times, it is in the middle of the night.
By Mary McDowell on June 5th, 2009 at 3:44 am
BABY ASPIRIN–I discovered by trial and error that one baby aspirin, chewed well and not swallowed immediately ( so that it gets into your blood sublingually and therefore almost immediately) will abort the pain of proctalgia fugax very quickly–under five minutes. I keep a bottle of baby aspirin beside my bed . The old-fashioned kind of baby aspriin, orange-flavored, and not the newer coated type, is best because the taste is not bad when chewed.This has never failed for me. I have an attack every couple of months.
By Bill on June 22nd, 2009 at 3:35 am
I have had this condition (I think) for years and it occurs about monthly. About four months ago I somehow made a connection to how I sleep. I often roll over onto my stomach and habitually pull my left leg up so I am sort of half on my side with one knee pulled up in a fetal like position, the other straight. I find it comfortable – always have. Because this wonderful “fugax” always starts in my sleep I am not really clear on my position when it starts. I used to think that I was maybe rolling over and pulling my leg up for comfort as it was coming on as I always seem to be coming awake in this position and in pain. Now, I slowly have started to realize that I feel a connection, a pull, between my raised leg and my anus and I have started to suspect that this sleeping position is actually bringing on the episode.
So, for the last four months I have been making a concious effort not to do this. I either pull both legs up (a full side sleeping almost fetal position) or both legs straight. I have now gone four months without an episode. This is not conclusive, of course, but I am sleepless tonight and for once it is not connected to a pain in the ___ so I thought I would share this.
By Cindy on October 14th, 2009 at 3:39 pm
Wow, my gynecologist couldn’t even diagnose this. I am like Lynda, but more specific, I have painful bouts if I orgasm while ovulating. My gynecologist did mention that a lack of testosterone after 35 and the weakening of my lining between vagina and anus may be the cause, but of what? I have almost passed out due to the pain but get through knowing I will live now that it has happened to me more than once. The first time almost killed me with fear.
By I P on October 17th, 2009 at 3:17 pm
I Have had a problem similar to Lynda’s for many years. The episodes are infrequent but seem to be increasing in intensity and duration. Last night I had two episodes. The first was quite severe and was triggered by a bowel movement. I found myself doing a lot of pacing until it subsided. It was the first time it was so severe and lasted so long. I really did not know how to help myself. I usually just let it run its course. I am glad that I read the postings on this site and I plan to implement some of the suggestions next time.
By G O on October 17th, 2009 at 3:48 pm
Lots of good information on this strange topis
By labi on October 18th, 2009 at 5:56 am
It’s true, it’s like stabbing or moving sharp glass on the skin make broses…
I agree , it might be related to perfectionists or very sensitive personalities, where we are keeping any discomforting or annoying situations inside us and not releasing or venting it out…
We need to change our ways of dealing with life, I will keep on trying…
By tamika on October 24th, 2009 at 10:52 pm
I am 26 yr old black female, I have never had an STD or any other medical problems in my pelvic area. I have been coping with chronic pelvic pain for 7 yrs. I have had paps, 2 ultrasounds, xrays and a colonoscopy but nothing has ever been found. Here are my symptoms: Throbbing pain in pelvic area (around where uterus and fallopian tubes are) Throbbing pain in lower rectum Pains sometime occur simultaneously Pain occurs before and/or after using bathroom Pain sometimes occurs during sex or after orgasm Pain occurs often during anytime of the day (including the middle of the night which wakes me) Pain is less frequent and not as strong during and immediately after menstrual cycle. Pain is immediate after eating spicy food. Pain occurs during exercise. Pain sometimes occurs when I am stressed. There is also a sharp pain when the wall between vagina and rectum is touched during sex or when I use those muscles down there ( sneeze, got to bathroom, pass gas)
I usually experience relief a couple minutes after using the bathroom. Bowel movements are often small though it feels larger before passing. There has been blood in stool but only 3 times in 7yrs which all can be explained by constipation or diarrhea. I have gas all the time (fortunately there no odor) I feel nauseous from time to time and some times if feel faint and sweaty during an episode.
I believe the issue is in my rectum because that’s where the pain occurs most often especially when I need to go #2. It is also affected by some foods, though I haven’t exactly figured out all of them. I just found out about proctalgia fugax online today and I think this is what I have. It makes me feel better already to know that I am not alone.
By Miller, J. on November 2nd, 2009 at 3:06 am
Thank you for your article. My husband is having his second episode tonight and the pain is unbearable.
My husband mentioned this to his Doctor at his last visit and the Doc said to take a dose of his Nitro spray. He said some people get this in their lifetime at times and called it "Phantom Pain". He said it may never happen again in my husbands lifetime. Well, here is his second episode. Oh, we changed Doctor's by the way as he was very uncaring and should have retired years ago.
So, after reading these articles, my husband will use hot compresses, try to bear down, have a hot bath, luckily he has a morphine pill to take and we'll pray it doesn't last long tonight.
Thanks everyone.
By Ray on November 24th, 2009 at 9:27 am
This article and all of your comments have been so helpful. I am now 99% sure this is what I have.
I have been getting these pains for the last year and finally decided that I had better see my doctor. When I had described all of the same symptoms that are in this articel she said, "Well, I've never heard of anything like that," and looked at me like I was nuts. When I insisted that the pain was real, she sent me for a prostate exam and an ultrasound. That was three months ago and I never heard word of any test results… I had come to the conclusion that I must be having some sort of OCD attack and that I was imagining things.
Thank you for the article… I'm certainly going to be shopping for a new Doctor.
By Kata Bliss on December 14th, 2009 at 8:18 am
I have the same experience when I take a few days off from training. I get it back quickly, and the awkwardness does go away too. I hear some folks can come back stronger even after taking 2 weeks off. I guess it depends on the person.
By Darla Belanger on December 16th, 2009 at 4:13 pm
What a relief to have found this article and related posts. I have suffered from this for 11 years now. The episodes are more frequent (from two a year to at least 2 a week) and painful then when they started. My doctor sent me for a colonoscopy, which revealed nothing , and I have just been dealing with the pain ever since as he did not have an explanation for the pain. It is difficult for others to understand what you are going through when you are pacing around whimpering and cursing at the mystery pain. I am glad to know there is a medical term for it, that others suffer as I do, and that it is not all in my head. I find bearing down helps for a bit, then when the pain starts to cut through that, I do the opposite and tighten the sphincter, and repeat back and forth until it is gone.
By Myriam on January 23rd, 2010 at 7:28 pm
HI,
I am a 22 year old female and I have had these shooting pains occur sporadically for about 4 years. I passed out at work because of it once. I think more people have this than we think, because it is considered embarrassing to talk about, especially for women. Here is the interesting part: my grandfather has them and so does my uncle (who also passed out from it). My grandfather found, through experimenting with his diet, that if he ate processed meat the pain would happen. As soon as he cut out processed meat, the pain stopped happening. My uncle started doing this and same happened with him – he stopped getting the pain. A very health-conscious guy, my grandfather has decided it's the nitrates in the meat (who knows?). I have been trying to cut out processed meats and have the cramp very rarely. When I do get it, I think back to what I ate the night before and it's usually some sort of processed meat or meat at a restaurant. After talking about this with my boyfriend, he admitted to having the pain occasionally as well. He gets it a lot more rarely than me though. Hope this helps some of you. I would be curious to hear back about whether it makes a difference or not. My pain is shooting, sometimes unbearable, never lasts more than 30sec or so, and happens during the day.
By Liam Thrush on January 26th, 2010 at 9:22 pm
Hello. This is kind of an “unconventional” question , but have other visitors asked you how get the menu bar to look like you’ve got it? I also have a blog and am really looking to alter around the theme, however am scared to death to mess with it for fear of the search engines punishing me. I am very new to all of this …so i am just not positive exactly how to try to to it all yet. I’ll just keep working on it one day at a time Thanks for any help you can offer here.
By Dave on February 19th, 2010 at 5:11 pm
I have had these for years. I read that a puff or two from an asthma inhaler helps if its salbutamol and it seems to help. I know that hot baths and compresses help but they aren’t quick enough so what I do now is I keep a hair dryer close by. When I feel the pain coming I hit it with the heat from the hair dryer, as hot as I can take it and I massage the area aggressively. I helps to shorten the episodes and make them bearable cus with the dryer you can get heat on it right away.
By danelle on February 21st, 2010 at 10:08 pm
what a great forum to read others’ experiences – thank you especially to bill… i usually sleep with one leg tucked up under me, exactly as he described. i am so glad that i may have found a solution by simply sleeping with both of my legs straight. i’m a 29 year old woman, and have the attacks about once a month – i wake up from a dead sleep and they last about 30 minutes. i finally got the courage to talk to my husband about my pain; he is an emergency room physician and immediately told me the name of this condition. he said it’s more common than people think, because nobody wants to admit this kind of pain to their physicians.
By lisa on February 23rd, 2010 at 5:42 pm
This has been happening to me for quite a while now, at least two years. Exact same symptoms as described above, during the night, extreme stabbing pain deep in the rectum. Quite scary at times. Even if there is no treatment or cure, after reading this article it is good to know that the condition is not serious and that I am not being paranoid with these symptoms.