Proctalgia fugax and anal pain: Causes and treatments
The condition is also known as functional recurrent anorectal pain. It is part of a group of disorders that affect the workings of the stomach and intestine.
Proctalgia fugax means “anal pain of unknown cause.” As the name suggests, the exact cause of the condition is unclear, but the pain is due to muscles in the anal canal and pelvic floor tightening suddenly.
This muscle tightening is called spasming. It is believed that spasms occur in the smooth muscles of the anal canal and the anal sphincter.
Some people may experience sudden and severe muscle cramps in their anal canal. These spasms are more likely to occur at night than at other times. Some people may experience several episodes of anal pain, and then go long periods without any problems.
Though proctalgia can occur without warning, the condition does have many triggers. These triggers can include:
Proctalgia fugax may be more likely to occur after treatments for certain other conditions. These treatments include sclerotherapy for hemorrhoids and vaginal hysterectomy.
As the symptoms vary from person to person and are similar to other medical conditions, similar conditions must be ruled out before making a definite diagnosis. These conditions can include hemorrhoids, abscesses, and fissures.
Diagnosis involves a thorough medical examination, including of the genital region. The doctor may also order blood tests and an endoscopy test to look at the lining of the bowel. An endoscopy test is when a doctor puts a small flexible tube into the body that has a light and camera.
In most cases, tests cannot confirm a diagnosis of proctalgia fugax specifically. Instead, the examinations can exclude other, more serious conditions.
Other anorectal pain syndromes
Anorectal pain is pain that affects the anus or rectum.
Levator ani syndrome is similar to proctalgia fugax but has a different pattern of pain. Levator ani syndrome causes spasms in the pelvic floor muscles. This is typically a result of injury in or around the pelvis, torso, or back.
Another condition that causes anal pain is a thrombosed external hemorrhoid. Here, a blood clot forms in an outer hemorrhoid in the anal skin. Larger clots can cause pain when walking, sitting, or when having a bowel movement.
Other anorectal pain syndromes include:
- anal fissure, a small rip or tear in the lining of the anal canal
- anal abscess, an infected cavity filled with pus located near the anus or rectum
- fungal infection or sexually transmitted diseases
- chronic constipation
- ulcerative colitis, a type of inflammatory bowel disease
- fecal impaction, a mass of hardened stool in the rectum due to chronic constipation
Treatment and lifestyle changes
Proctalgia fugax does not cause any lasting damage to people, but it is painful. Treatment focuses mostly on pain relief.
There are treatment options that may help to relax the anal muscles and keep them from spasming. These include:
- oral diltiazem, a drug that treats high blood pressure
- topical glyceryl nitrate, a pain-relieving drug
- nerve blocks, substances that numb nerves
- muscle relaxers
The problem is that the effectiveness of these treatments vary greatly. As the proctalgia fugax episodes can occur without warning and last a short amount of time, medicine often does not take effect in time. Most people do not worry about taking medicine and instead just let the episodes pass.
There are, however, some natural treatment remedies that people can try to help relieve the pain:
- Natural vegetable powder: Consuming this powder can help produce large, soft bowel movements that help to stretch out the muscles and prevent spasms.
- Pelvic muscle retraining: If voluntary muscles are in spasm, a person may be able to train their muscles to relax by doing special exercises.
- Warm baths: May help to relax the anal sphincter and reduce the spasms and pain associated with proctalgia fugax.
- Potassium-rich foods: Potassium deficiency is thought to be associated with proctalgia fugax. Bananas, raisins, and avocados are rich in potassium.
- Relaxation techniques: Stress relievers such as meditation, deep-breathing exercises, and yoga may help to relieve anxiety and stress.
Treatment for anorectal pain syndromes varies depending on the type. Many conditions simply heal on their own, over time.
Over-the-counter creams and pain relievers work for many people. In some instances,antibiotics may be necessary to fight infections. Surgery or other procedures may also be needed.
There are some measures that people can take to try and relieve their anorectal syndromes. Eating more fruits and vegetables is a good start.
Vegetables, whole grains, exercise, and stool softeners help with bowel movements. They help to keep people from getting constipated as well as reducing strain and easing the pain. Over-the-counter hemorrhoid cream and pain relievers can also help to clear up mild cases.
Proctalgia fugax is not life-threatening and causes more discomfort than anything. There are many causes of anal pain but most are easily treatable.
Most anorectal pain syndromes are not dangerous, but it is important to understand when to contact a doctor. People should seek immediate treatment if their anal pain does not go away within 24 to 48 hours, or if they experience any of the following symptoms:
- a large amount of continuous rectal bleeding that may be accompanied by lightheadedness or dizziness
- anal pain that does not get better after several days or seems to gets worse
- anal pain that spreads in addition to fever, chills, or anal discharge
- severe pain
People should also pay attention to any changes in bowel movement. A doctor will want to know exactly what has been going on so they can treat the person. Rectal bleeding is especially dangerous as it can be a sign of colon cancer.
Anorectal bleeding can be caused by hemorrhoids, fissures, polyps, or inflammatory bowel disease. Any bleeding should be carefully looked at and diagnosed.Anal cancer is also a possibility.
A colonoscopy may be needed to discover the reason for the bleeding. This procedure is a form of endoscopy, where a special tube with a light and camera is inserted into the colon through the rectum.
Most causes of anal pain are not related to cancer, but tumors can cause bleeding, pain, and changes in bowel habits. Early detection is the key to successful treatment of all anorectal pain syndromes.