Proctalgia Fugax

What is proctalgia fugax?

Proctalgia fugax is severe anal pain that comes on suddenly, lasts briefly and often disappears as unexpectedly as it began. The anal pain isn’t a one-time thing. Instead, it recurs (comes back) in episodes that may happen over several weeks or months. Proctalgia fugax doesn’t involve tissue damage, but the pain can be so intense that it prevents you from going to work or school.

The word provides clues as to what’s involved.

• “Proctalgia” is the medical term for pain in your anus or rectum. The pain associated with proctalgia fugax involves the nerves and muscles associated with these organs. Your rectum is the last 6 inches of your large intestine that’s directly above your anus (butthole). Your anus is the last few inches of your gastrointestinal (GI) tract. It contains sphincter muscles that remain squeezed until they relax so you can poop.
• “Fugax” comes from a Latin word meaning “fleeting” or “brief.” The anal pain associated with proctalgia fugax may last for a few seconds up to 30 minutes.

How common is proctalgia fugax?

Researchers estimate that up to 18% of the general population experiences proctalgia fugax. Of this total, only approximately 20% see a healthcare provider about their pain.

What are the symptoms of proctalgia fugax?

The primary symptom of proctalgia fugax is anal pain that occurs in brief (30 minutes or less) episodes. Episode frequency varies. Some people have a few attacks a year while some have several.

The pain associated with proctalgia fugax:

• Tends to feel sharp as opposed to dull, achy or crampy.
• Feels as if it’s coming from inside or near your anus (instead of farther up inside you).
• Usually happens out of nowhere, although there may be triggers.
• Can start during the day or at night (potentially waking you from sleep).

Symptoms are often severe enough to cause you to stay home from school or delay going to work.

What does proctalgia fugax feel like?

Some people with proctalgia fugax describe the pain as feeling like a charley horse (leg muscle spasm) that’s in your anus. While you’re in the midst of an episode, it can be hard to concentrate on anything other than needing the pain to stop. It can feel as if there’s no end in sight, but there always is.

What causes proctalgia fugax?

There isn’t a single, known cause. Some studies show that proctalgia fugax may arise from:

• Muscle spasms: Spasms in your anal sphincter muscles or other pelvic floor muscles can cause anal pain.
• Nerve problems: Damage to your pudendal nerve, also called pudendal neuralgia, may lead to proctalgia fugax. Your pudendal nerve carries electrical signals that allow you to experience sensations in your pelvic muscles, including muscles in your anus.

Proctalgia fugax may be a complication of a procedure on your pelvic area. It’s common after:

• Sclerotherapy for hemorrhoids: This procedure injects a chemical into hemorrhoids (swollen veins in or around your anus) to shrink them.
• Vaginal hysterectomy: This procedure removes your uterus through your vagina.

It’s also associated with certain conditions. You’re more likely to have proctalgia fugax if you have:

• Irritable bowel syndrome (IBS).
• An anxiety disorder.

What triggers proctalgia fugax?

Usually, proctalgia fugax doesn’t involve triggers. The pain just starts out of the blue. For some people, though, proctalgia fugax seems to happen alongside or because of:

• Stress.
• Sex.
• Menstruation (periods).
• Having a bowel movement (pooping).

What are the risk factors?

Proctalgia fugax is more common in people assigned female at birth AFAB). Age is a risk factor, too. It’s more commonly diagnosed in adults between ages 30 and 60.

How is proctalgia fugax diagnosed?

Proctalgia fugax is a diagnosis of exclusion. This means your healthcare provider will diagnose you with proctalgia fugax based on your symptoms after they rule out other, more common causes of anal pain. Before you get diagnosed, they may exclude:

• Anal fissures.
• Anal cancer.
• Hemorrhoids.
• Rectocele.
• Ulcers or abscesses.
• Irritable bowel disease (IBD).
• Pelvic inflammatory disease (PID).

Understanding your symptoms will help your provider make a diagnosis. While anal pain is a common symptom, it can be helpful to note what’s unique about your experience. Share with your provider:

• What the pain feels like.
• How long pain episodes last.
• How frequently you have pain episodes.
• If you’ve noticed any triggers.

It can be hard to share details about anal pain, just because many of us were taught as children that “butt talk” (pooping, farting, buttholes, etc.) is impolite conversation. Remember that it’s never impolite to share information about your health — including anal pain — with your provider. Don’t hesitate or feel embarrassed. This information only helps your provider arrive at a diagnosis and a solution that can provide you relief more quickly.

What tests will be done to diagnose this condition?

There isn’t a specific test to diagnose proctalgia fugax. But you may need several tests to rule out other conditions. Tests may include:

• Blood tests.
• Digital rectal exam.
• Pelvic exam.
• Colonoscopy.
• Flexible sigmoidoscopy.
• Pelvic floor test.

How is proctalgia fugax treated?

There’s no cure for proctalgia fugax. Instead, treatment involves avoiding any known triggers and easing your symptoms until the episode passes. Depending on the severity of your symptoms, you may be able to manage things at home. Or you may need prescription medications or a procedure to bring relief.

Home remedies

Pain relief management you can try at home includes:

• Applying a heating pad or ice pack to the area.
• Soaking your anus in a warm bath or sitz bath.
• Taking over-the-counter (OTC) pain relievers.
• Trying relaxation techniques, like meditation or yoga.

Prescriptions and in-office treatments

See your healthcare provider for treatment if home remedies aren’t helping. Treatments include:

• Medicines you apply to your anus, including nitroglycerin ointment.
• Botox injections to relax the sphincter muscle.
• Electrical stimulation, a procedure that uses a probe that releases electrical signals to calm anal muscle contractions.
• Pelvic floor physical therapy with biofeedback, a procedure that uses sensors to teach you how to be more mindful of your body’s sensations. Biofeedback can teach you to recognize when your anal muscles are tense so you can relax them.
• Counseling or therapy, to get a handle on anxiety and stressors that may be related to your anal pain.

What can I expect if I have proctalgia fugax?

There isn’t one outcome to expect with proctalgia fugax. Some people experience a few episodes and aren’t bothered with anal pain again. Others have frequent episodes that interfere with their day-to-day lives.

Your experience will depend on how severe your pain is and how often you have episodes. Work with your healthcare provider to get the treatment you need. Or have treatments on hand (like topical gels) to ease pain quickly if an episode starts.

When should I see my healthcare provider?

See your healthcare provider if you have recurring episodes of anal pain or pain that persists. Don’t let embarrassment keep you from getting diagnosed and treated.

What questions should I ask my healthcare provider?

Questions to ask include:

• What tests will I need to diagnose my condition?
• What’s likely causing my anal pain?
• What treatments would you recommend?
• What steps can I take so I’m prepared for a future pain episode?

What’s the difference between proctalgia fugax and chronic proctalgia (levator ani syndrome)?

The “fleeting” part of this condition is important. If the pain episodes last longer than 30 minutes, you may have chronic proctalgia. Chronic proctalgia is also called levator ani syndrome. Your levator ani is an essential muscle in your pelvic floor. It’s also the origin of the anal pain in levator ani syndrome.

Unlike proctalgia fugax, pain from levator ani syndrome feels higher up inside your pelvis, not closer to your anus. It may feel dull or achy instead of sharp. Also, it’s usually worse when you’re sitting. In contrast, body positioning doesn’t typically make a difference with proctalgia fugax.

A note from Cleveland Clinic

Any type of pain is an unwelcome visitor — but this may feel especially so when the pain’s in a place as sensitive and private as your anus. The experience can feel both miserable and embarrassing. But there’s nothing embarrassing about any pain you’re feeling. Your body is filled with nerves and muscles that help you function and cue you into problems. As with any body part, things can go wrong and cause you to experience symptoms like pain. The key is doing something about it. Don’t let embarrassment keep you from getting the help you need.