Pain is part of life. Headaches, stiff knees, and sudden back pain may make you feel uncomfortable. Similarly, you may have pain in your buttocks.
Proctalgia fugax is pain or cramping felt around your buttocks and rectum. The rectum is the last part of the large intestine, ending in the anus, which removes solid waste from the body.
This pain is the result of spasms or cramps of your pelvic floor muscles, anal sphincter muscles, or rectum muscles. Because proctalgia fugax is unpredictable, it is difficult for doctors to diagnose or researchers to study.
Symptoms
Proctalgia fugax is temporary rectal pain. You may have intense pain for a short time. Cramps in your rectum may last from a few seconds to several minutes.
Severe episodes of proctalgia fugax can be painful enough to wake you up from your sleep or keep you from going to work or school. Between episodes, you probably won’t have any pain or discomfort. If you do have pain that isn’t coming from another spasm, another anorectal condition may be causing it, so talk to your doctor to rule out other conditions.
Chronic proctalgia fugax. Episodes of chronic proctalgia fugax usually last for more than 20 minutes and happen more often than occasionally. Other long-term symptoms include discomfort from sitting for too long and painful bowel movements.
Proctalgia Fugax vs. Levator Syndrome
Proctalgia fugax is a form of levator syndrome (also called levator ani syndrome). Both include spasms of muscles in the pelvic area. Proctalgia fugax is temporary, but other types of levator syndrome can last for several days.
Another major difference is the location of the pain. Pain from proctalgia fugax is felt mainly in the rectum. Pain due to levator syndrome is felt in the pelvic floor — specific or vague areas — and in the thighs and buttocks.
Symptoms of levator syndrome are usually felt higher in the pelvis than the symptoms of proctalgia fugax. You may notice that symptoms worsen when sitting and improve when standing or lying down.
Causes
Finding the cause of proctalgia fugax may be difficult. The causes vary from person to person and need different approaches for treatment. Other conditions in the anorectal area may cause spasms that seem similar to proctalgia fugax but are diagnosed and treated as separate issues. Sometimes an underlying condition causes proctalgia fugax, and treating that condition will relieve the symptoms of proctalgia fugax.
Stress. Proctalgia fugax may be related to stress and anxiety. In some cases, people with proctalgia fugax felt stressed just before the spasms.
Studies have shown a similar relationship between stress and levator syndrome. Many people with levator syndrome have psychosocial distress, including depression and anxiety.
The following activities may cause proctalgia fugax:
- Sexual activity
- Constipation
- Abnormal bowel movement
- Menstruation
Diagnosis
Proctalgia fugax is difficult to diagnose because of how quick and random the spasms can be. There are no tests for proctalgia fugax. But your doctor will rule out other possible causes for your anorectal pain.
Other anorectal conditions your doctor may check for are:
- Hemorrhoids
- Ulcers, abscesses, or other abnormal growths
- Anal fissures, or small tears
- Inflammatory bowel disease
History. Your doctor may make a diagnosis based on your symptom history. Keep an accurate record of when the spasms happen, how long they last, how severe they are, and what happened before the spasms to help your doctor make a better diagnosis.
Physical exam. Your doctor may do a physical exam to check for places of tenderness in the rectum, or pain when the area is touched. Tenderness in the rectum or its nerves can be the cause of proctalgia fugax. A similar physical exam is performed to rule out any other conditions that cause anorectal pain.
Treatment
Most treatment options for proctalgia fugax depend on the symptoms. Treatments aim to ease pain and discomfort. This is mainly because the episodes are short, irregular, and without a clear cause.
At-home treatment. Before trying treatment options, check with your doctor to rule out other causes. You can take care of your symptoms on your own with the following methods:
- Over-the-counter (OTC) antispasmodic drugs
- OTC muscle relaxers and pain relievers
- Warm baths
- Heating pads and ice packs
Another at-home method that may help you avoid proctalgia fugax is to eat more fiber. Fiber will allow you to have softer bowel movements. These will keep your anorectal muscles from working too hard and may lower the risk of proctalgia fugax spasms.
Injections. For more severe pain, your doctor may recommend a variety of injections to stop muscle spasms. A Botox injection around the anorectal areas will relax the muscles. An epidural injection or a local anesthetic will numb the pelvic areas to ease muscle spasms.
Electrical stimulation. For severe proctalgia fugax, electrical stimulation of the anorectal muscles may provide relief. This treatment option involves inserting a small, finger-sized probe into the rectum and using a low voltage current to relax spastic muscles through vibration.
