Rectal Pain (Proctalgia Fugax)

A doctor putting on his glove. (iStockphoto/Thinkstock)
A doctor putting on his glove. (iStockphoto/Thinkstock)

A patient asks: I have pain in my rectal area and I have been told that I have proctalgia fugax. What is this condition and how can I get some relief?

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).

Proctalgia fugax is not part of the list as it is not that common. But unfortunately it is not that rare either. It occurs in about 14 percent of healthy people. Seventy five percent of these are women.

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 means pain in the rectum. Fugax means flying, fleeting, momentary like a fugitive – trying to elude justice!

Proctalgia fugax is an intensely painful spasm in the rectal area that begins abruptly and lasts for several minutes. It can begin during sleep, defecation, urination, or intercourse. The character of the pain has been compared to a charley horse.

Sharp cramp or stabbing pain may awaken the patient from sleep. It lasts less than 30 minutes and may radiate to the coccyx or perineum. 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 symptoms. 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, message 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.

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8 Replies to “Rectal Pain (Proctalgia Fugax)”

  1. This is a most helpful article. I have been wrestling with what appears to be proctalgia fugax for some months. Several of the remedies have been tried. I have found some relief, but cannot say for sure which particular route had been most successful. Thanks for enlightening me a great deal.

  2. Sitting on the floor on a rubber ball (the smaller baseball sized ndia rubber kind) will not remove the pain but will make it more bearable for the duration of the spasm. Shifting position as necessary suggested. Remaining stationary does nothing to help, moving around is better.

  3. I have suffered with this for over 30 years, but have just NOW been given a name for it. It used to only come in the daytime, but over the last few years will also wake me up at night. It usually lasts 20-40 minutes. The best thing I have found to do is a sort of ‘football run’….running on the spot but with feet sort of out to the side. I worry that I won’t be able to do this as well when I’m in my 70s and 80s, which are fast approaching!

    1. The only thing that seems to give me a little relief is to put pressure on my pubic bone with my fingers (sounds funny but not when it’s happening). I need to press as hard as I can and it relieves the pressure a bit. I guess it’s comparable to sitting on a tennis ball which some people do. I’m 50 yo now and have been suffering since I’m a child. I just learned what it is. I never thought of searching the internet until today!

  4. Sit on the edge of your bath tub you’ll know when your in the right spot, from then on its a guessing game as to when it’s finished running its course, what I do is put the kettle on have a sit down on the tub test how the pain is by walking to make tea, sometimes it’s ok and 1 sit down is enough but other times maybe up to 5 times which is where I’m at right now, tea iPad helps deal with the pain and boredom of sitting on the edge of your bath! 26 years old had for as long as I can remember

  5. Thank you for this informative article. I have had this condition on and off for about 6 years. My hunch is that it started when I began the sport of powerlifting. Lifting very heavy weights puts a tremendous amount of pressure on the “kegel” muscles. The same muscles you use to cut off flow of urine. It took me this long to realize that the pain only seems to come after heavy sessions of squats or deadlifts. I believe 3 cups a day of coffee is not helping me either. My plan is to eliminate caffeine from my diet and take a break from heavy lifting for a few weeks. I will update here with my progress. Thank you so much for this article Dr. Bharwani

  6. I have had this since I was a very young child. I remember feeling faint and breaking out into sweats it was so bad. Now I am 50 and I often get a mild version of it at night or after sitting still for a long time. Another time I get it is when I am playing sports. When it’s triggered by sports the pain is usually intense, can’t talk, have to sit quietly off by myself until the pain subsides. Never quite figured out how to explain to team mates without them getting really weirded out. When I was in my 20’s I tried to tell a doctor about it but to no avail and much embarrassment. Anyway, I appreciate reading other’s comments and not feeling alone in this strange condition. Thanks for the info Doctor Bharwani.

  7. having suffered from this for many years, I finally found the cure… keep your magnesium levels up. check levels with RBC mg test. for those still suffering the short term help is sitting in warm tub of water.

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