Proctalgia fugax was first described in Ancient Rome over 2000 years ago and still carries the Latin name which translates to “fleeting rectal pain.” I wrote about this some years ago. If you go to my website (nbharwani.com) and search proctalgia fugax, you will find that this is the most discussed article – more than 100 people have shared their experience with this condition.
Because of my interest in this, my attention was drawn to an article in the Canadian Medical Association Journal (CMAJ March 19 2013) titled “Five things you should know about proctalgia fugax.”
First thing you should know is proctalgia fugax has many triggers. There are episodes of sharp fleeting pain that recur over weeks, are localized to the anus or lower rectum, and last from seconds to several minutes with no pain between episodes. The authors of the article say that there are numerous precipitants including sexual activity, stress, constipation, defecation and menstruation, although the condition can occur without a trigger.
Second thing you should know is proctalgia fugax is common. In the general population, the prevalence of the condition may be as high as eight to 18 per cent. Seventy five per cent are women. It usually affects patients between 30 and 60 years of age.
Third thing you should know is that anal sphincter spasm may cause the pain in proctalgia fugax. The authors say that although the cause of proctalgia fugax is unclear, spasm of the anal sphincter is commonly implicated. It may occur after sclerotherapy for hemorrhoids and vaginal hysterectomy. Stress, anxiety and irritable bowel syndrome may be associated with proctalgia fugax.
Fourth thing you should know is proctalgia fugax is a diagnosis of exclusion. That means there is no test to tell if the person is suffering from this condition. We have to exclude common painful conditions of anus and rectum before we can say a person is suffering from proctalgia fugax. These conditions are: hemorrhoids, cryptitis, ischemia, abscess, fissure, rectocele and cancer.
Finally, the fifth thing you should know about this condition is that the treatments are geared towards relaxing the anal sphincter spasm. These treatments are: oral diltiazem, topical glyceryl nitrate (gives you headache), nerve blocks and salbutamol act by relaxing the anal sphincter spasm. But these treatments are not very effective.
Persistent symptoms require thorough investigations of anal and rectal areas and if no pathology is found then reassurance to patient is very important. There is no known effective treatment for this condition. There are anecdotal reports of benefit from trying any of the following treatments:
-Reassurance and warm baths
-Topical glyceryl trinitrate 0.1 per cent or diltiazem two per cent whenever required
-Salbutamol inhalation 200µg regular three times a day or whenever required
-Warm water enema at the time of symptoms
-Clonidine 150µg twice a day
-Local anesthetic block or botulinum toxin injection
-Help to relieve anxiety and stress
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