Proctalgia fugax
Encyclopedia
Proctalgia fugax is a severe, episodic, rectal and sacrococcygeal
pain. It can be caused by cramp of the pubococcygeus
or levator ani
muscles.
and aching lasting twenty minutes or longer. In a study published in 2007 involving 1809 patients, the attacks occurred in the daytime, (33 percent) as well as at night (33 percent) and the average number of attacks was 13. Onset can be in childhood, however, in multiple studies the average age of onset was 45. Many studies showed that women are affected more commonly than men.
During an episode, which sometimes occurs after orgasm, the patient feels spasm-like, sometimes excruciating, pain in the anus, often misinterpreted as a need to defecate. Simultaneous stimulation of the local autonomic system can cause erection in males. Because of the high incident of internal anal sphincter thickening with the disorder, it is thought to be a disorder of the internal anal sphincter or that it is a neuralgia of pudendal nerves. It is recurrent and there is also no known cure. However, some studies show effective use of botulinum toxin
, pudendal nerve block, and calcium channel blocker
s. It is not known to be linked to any disease process and data on the number of people afflicted varies, but is more prevalent than usually thought.
The pain episode subsides by itself as the spasm disappears on its own, but may reoccur.
(if the pain lasts long enough to draw a bath), warm to hot enemas, relaxation techniques, and various medications.
In patients who suffer frequent, severe, prolonged attacks, inhaled salbutamol
has been shown in some studies to reduce their duration.
Caffeine
or other stimulants almost instantaneously relieve pain once ingested. However, seeing as most Proctalgia fugax episodes occur at night, the 'upper' effects from the treatment might cause an unwanted loss of sleep.
The use of botulinum toxin
has been proposed as analgesic, and low dose diazepam
at bedtime has been suggested as preventative.
The most common approach is simply reassurance and topical treatment.
Sacrococcygeal
Sacrococcygeal can refer to:* Sacrococcygeal teratoma* Anterior sacrococcygeal ligament* Posterior sacrococcygeal ligament* Sacrococcygeal symphysis* Sacrococcygeal membrane...
pain. It can be caused by cramp of the pubococcygeus
Pubococcygeus muscle
The pubococcygeus muscle or PC muscle is a hammock-like muscle, found in both sexes, that stretches from the pubic bone to the coccyx forming the floor of the pelvic cavity and supporting the pelvic organs. It is part of the levator ani group of muscles.-Function:The Pubococcygeus muscle controls...
or levator ani
Levator ani
The levator ani is a broad, thin muscle, situated on the side of the pelvis.It is attached to the inner surface of the side of the lesser pelvis, and unites with its fellow of the opposite side to form the greater part of the floor of the pelvic cavity....
muscles.
Presentation
It most often occurs in the middle of the night and lasts from seconds to minutes, an indicator for the differential diagnosis of levator ani syndrome, which presents as painPain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
and aching lasting twenty minutes or longer. In a study published in 2007 involving 1809 patients, the attacks occurred in the daytime, (33 percent) as well as at night (33 percent) and the average number of attacks was 13. Onset can be in childhood, however, in multiple studies the average age of onset was 45. Many studies showed that women are affected more commonly than men.
During an episode, which sometimes occurs after orgasm, the patient feels spasm-like, sometimes excruciating, pain in the anus, often misinterpreted as a need to defecate. Simultaneous stimulation of the local autonomic system can cause erection in males. Because of the high incident of internal anal sphincter thickening with the disorder, it is thought to be a disorder of the internal anal sphincter or that it is a neuralgia of pudendal nerves. It is recurrent and there is also no known cure. However, some studies show effective use of botulinum toxin
Botulinum toxin
Botulinum toxin is a protein produced by the bacterium Clostridium botulinum, and is considered the most powerful neurotoxin ever discovered. Botulinum toxin causes Botulism poisoning, a serious and life-threatening illness in humans and animals...
, pudendal nerve block, and calcium channel blocker
Calcium channel blocker
A calcium channel blocker is a chemical that disrupts the movement of calcium through calcium channels.CCB drugs devised to target neurons are used as antiepileptics. However, the most widespread clinical usage of calcium channel blockers is to decrease blood pressure in patients with...
s. It is not known to be linked to any disease process and data on the number of people afflicted varies, but is more prevalent than usually thought.
The pain episode subsides by itself as the spasm disappears on its own, but may reoccur.
Treatment and prevention
Traditional remedies have ranged from warm bathsBathing
Bathing is the washing or cleansing of the body in a fluid, usually water or an aqueous solution. It may be practised for personal hygiene, religious ritual or therapeutic purposes or as a recreational activity....
(if the pain lasts long enough to draw a bath), warm to hot enemas, relaxation techniques, and various medications.
In patients who suffer frequent, severe, prolonged attacks, inhaled salbutamol
Salbutamol
Salbutamol or albuterol is a short-acting β2-adrenergic receptor agonist used for the relief of bronchospasm in conditions such as asthma and chronic obstructive pulmonary disease. It is marketed as Ventolin among other brand names....
has been shown in some studies to reduce their duration.
Caffeine
Caffeine
Caffeine is a bitter, white crystalline xanthine alkaloid that acts as a stimulant drug. Caffeine is found in varying quantities in the seeds, leaves, and fruit of some plants, where it acts as a natural pesticide that paralyzes and kills certain insects feeding on the plants...
or other stimulants almost instantaneously relieve pain once ingested. However, seeing as most Proctalgia fugax episodes occur at night, the 'upper' effects from the treatment might cause an unwanted loss of sleep.
The use of botulinum toxin
Botulinum toxin
Botulinum toxin is a protein produced by the bacterium Clostridium botulinum, and is considered the most powerful neurotoxin ever discovered. Botulinum toxin causes Botulism poisoning, a serious and life-threatening illness in humans and animals...
has been proposed as analgesic, and low dose diazepam
Diazepam
Diazepam , first marketed as Valium by Hoffmann-La Roche is a benzodiazepine drug. Diazepam is also marketed in Australia as Antenex. It is commonly used for treating anxiety, insomnia, seizures including status epilepticus, muscle spasms , restless legs syndrome, alcohol withdrawal,...
at bedtime has been suggested as preventative.
The most common approach is simply reassurance and topical treatment.