Proctalgia Fugax
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Definition/Description[edit | edit source]
Proctalgia fugax or functional recurrent anorectal pain, a spasm of pelvic floor muscles, anal sphincter muscles, or rectal muscles causing episodes of severe stabbing anal pain in the absence of an organic disorder to explain pain, lasting for a few seconds or minutes, and repeats for weeks with no pain between episodes. The severity can be severe enough to wake the patient from sleep. The pain is localized to the lower rectum and anus[1]. While chronic proctalgia is a dull ache or pressure-like sensation in the rectum that is worse with sitting than standing[2].
Clinically Relevant Anatomy[edit | edit source]
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Epidemiology /Etiology[edit | edit source]
It is a transitory disorder that usually does not need further investigations and can be treated by a primary health care physician. It is difficult to detect its prevalence as the patient does not seek a doctor's help unless the symptoms become severe it represents about 8- 18%[3]and is more common among women than men with 30 and 60 years most affected age[2].
Abnormal smooth muscle contraction and the increase in anal pressure were suggested to be the cause of pain sensation, because the intermittent, infrequent, and the short duration of the pain associated with proctalgia fugax make identifying its mechanism difficult.
The definite causes of proctalgia are still unclear but first, exclusion of any pelvic or anorectal pathophysiology is important. Proctalgia fugax is common after vaginal hysterectomy, sclerotherapy for hemorrhoids, and intramuscular abscess[4]. Anxiety, stressful conditions, and irritable bowel syndrome in addition to an abscess, anal fissure, or hypertrophy of the internal anal sphincter[5].
Characteristics/Clinical Presentation[edit | edit source]
The patient will complain from episodes of localized pain at the lower rectum and anus, the episode lasts for second to minutes (20 minutes maximum) with no pain between episodes. Symptoms may occur once per month, with no factors that trigger symptoms, however, anxiety and stress may induce symptoms[4].
A study demonstrated the recurrence of proctalgia fugax less than 5 times/ year in 51% of patients.
Differential Diagnosis[edit | edit source]
- Levator ani syndrome.
- Chronic proctalgia[2].
- Chronic benign prostatitis.
- Urogenital abnormalities[4].
Diagnostic Procedures[edit | edit source]
Rome III diagnostic criteria for proctalgia fugax include the following:
- Recurrent anal or lower rectum pain episodes.
- Episodes last from seconds to minutes maximum of 20 minutes and sometimes last up to 30 min according to Rome IV criteria[6].
- No anorectal pain between episodes.
In research, it is important for symptoms to be checked for 3 months while in clinical practice proctalgia can be diagnosed before three months[6][6].
Outcome Measures[edit | edit source]
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Medical Management[edit | edit source]
The episodes of pain are brief and infrequent and usualy they don’t need treatment for those patients reassurance and explanation the disorder to the patient is recommended. For patients suffering from long, frequent symptoms:
Physical Therapy Management[edit | edit source]
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Resources[edit | edit source]
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Clinical Bottom Line[edit | edit source]
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References[edit | edit source]
- ↑ Jeyarajah S, Purkayastha S. Proctalgia fugax. CMAJ. 2013 Mar 19;185(5):417-.
- ↑ 2.0 2.1 2.2 Bharucha AE, Trabuco E. Functional and chronic anorectal and pelvic pain disorders. Gastroenterol Clin North
- ↑ Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Thompson WG, et al. U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci. 1993;38(9):1569–80
- ↑ 4.0 4.1 4.2 Bharucha AE, Wald A, Enck P, Rao S. Functional anorectal disorders. Gastroenterology. 2006 Apr 1;130(5):1510-8.
- ↑ Celik AF, Katsinelos P, Read NW, Khan MI, Donnelly TC. Hereditary proctalgia fugax and constipation: report of a second family. Gut. 1995 Apr 1;36(4):581-4.
- ↑ 6.0 6.1 6.2 Simren M, Palsson OS, Whitehead WE. Update on Rome IV criteria for colorectal disorders: implications for clinical practice. Current gastroenterology reports. 2017 Apr;19(4):1-8.
